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WY 141 W949i 1919 




AN HEX .', 


W.D.S.Q.f 3_ 5 13 




MACMILLAN & CO., Limited 









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All rights reserved 

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Set up and electrotyped. Published July, 1919] 


To the preparation of this manual many industrial nurses 
have given freely from their experience and thought. 

It is recognized that each plant and each industiy is a 
separate problem requiring an elastic and flexible nursing 
service. It is not too much to expect, however, that there will 
be ultimate standardization of certain necessary methods, 
records, equipment, restrictions, etc., which will mean 
greater efficiency and safety. 

Any standards worked out at the present time (1919) will 
doubtless require modification in the days to come in order 
to meet future industrial and social developments. 

The writer hopes to present to pupil nurses, and to others 
who wish to take up industrial nursing, an idea of the condi- 
tions under which they may have to work and to emphasize 
the need of as thorough a training as possible. To those who, 
because the need is urgent must enter the field with little 
more preparation than a hospital training, this volume may 
serve as a guide to careful self-preparation while engaged in 
the work. It may also give to some employer, who still 
doubts the value of the trained nurse in industry, an idea of 
what the nurse can do for his organization, employes and 

Because the work of the industrial nurse is so varied, be- 
cause she is working in so many different industries, and 
because in no two places are her duties and responsibilities 
the same, it is very difficult to write about her work in a 
general way. Nurses are successfully employed in most 
large and in many small industries; in mills, factories, hotels, 
department stores, laundries and tanneries, in mining villages 
and other industrial communities, by insurance companies, 
banks and trust companies. 




They are doing first aid work, sanitary inspection, accident 
prevention work; they are working afc employment problems, 
supervising lunch rooms and rest rooms; they are teaching 
first aid, hygiene, home nursing, child care, English. 

As industrial visiting nurses, they are caring for the sick in 
their homes, teaching in these homes the care of children 
and elementary nursing principles; helping in the making of 
Americans from our masses of foreigners. They are doing the 
work of public health nursing in communities where, without 
them, little would done for the prevention of sickness. 

As agents of their employers, they are sometimes acting as 
health officers, tenement inspectors, recreation managers, 
and school nurses. 

The nurse may be employed by various persons; an em- 
ployer of labor, an organization of employers of labor with 
their workers, an employes' benefit association or a labor 
union. The term employer in relation to the nurse will be 
used as meaning the person or organization who has engaged 
her, who pays her and to whom she holds herself responsible 
for the proper performance of her duties and for the welfare 
of her patients. It seems wise to devote the most attention 
to the nurse in the small plant whose duties have frequently 
a wide range and who is often working alone except for the 
assistance of the company doctor. As the larger number of 
industrial nurses are probably employed in manufacturing 
plants, the nomenclature of such concerns will be used. 

The principles of industrial nursing, however, apply equally 
to all branches. In a factory the nurse deals with owners, 
general manager, heads of departments, foremen, machine 
hands, etc. In a department store she deals with owners, 
general manager, floor managers, buyers, salespeople, etc. 

For information, assistance and advice in the preparation 
of this manual, the writer is indebted to many who have been 
generous of time and thought; among them being: Miss 
Ella Phillips Crandall, Executive Secretary of the National 
Organization for Public Health Nursing; Miss Mary S. 
Gardner, Director of the American Red Cross Public Health 



Nursing Service; Mrs. Bessie Amerman Haasis, Educational 
Secretary of the National Organization for Public Health 
Nursing; Mrs. Claribel Hill for assistance in gathering mate- 
rial for the records of the nurse in the employment office; 
Miss Frances Young, Librarian, National Organization for 
Public Health Nursing for assistance in the preparation of 
the bibliography; and Miss Ada M. Carr, former Head of the 
Educational Department of the Boston Instructive Visiting 
Nurse Association, for valuable assistance in the preparation 
of the manuscript, in the reading of the proof and for much 
wise counsel. 



A Brief Account of the Development of Industrial Nursing 1 

The Qualifications and Training of the Industrial Nurse ... 9 

Elementary Principles of Industrial Nursing. 14 


The Industrial Nurse and her Fellow Workers 18 


The Industrial Nurse and the Community 28 


The First Aid Room Nurse 32 


The First Aid Room 51 

The Visiting Nurse in Industry 70 


The Day's Work 81 


Records and Reports for the First Aid Room and for the 

Visiting Nurse 90 




The Industrial Norse and the Employment Office. Records 99 


The Industrial Nursing Center 124 

Food. The Company Lunch Room 142 


A Few Questions which Mainly Concern the Industrial 
Nurse Herself 150 


What Industrial Nursing Offers to the Nurse 156 


First Aid Rules 159 

Sources of Information on Public Health Subjects 165 

Bibliography 169 

Index 175 





About the middle of the last century we see the employer 
waking to a sense of responsibility for the welfare of his 
workers. In 1842 Dickens described what was probably 
one of the first industrial hospitals in the United States 1 and 
in 1852 an English employer 2 issued a report of "The Educa- 
tional, Religious and Moral Charge to be taken by the Com- 
pany over the Persons (and especially the young persons) 
in its Employment." Many early efforts for industrial wel- 
fare were of such a paternal nature as would be scorned 
by the average employe of this generation. 3 

The Pullman strike in 1894 is often quoted as a strong 
argument against industrial welfare efforts. The Pullman 
plan was instituted in 1880. There was no provision for a 
nursing service. Although excellent, and acceptable in 
many ways to self-respecting workers, its failure seems to 
have been due to a paternalistic attitude on the part of the 
employer. The effort to force the purchase of supplies at 
the company store and dictation as to the personal habits 
of the workers was probably the direct cause of discontent. 

1 "American Notes", by Charles Dickens, Chapter IV. 

2 Price's Patent Candle Company, Report 1852. New York Public 
Library. , . 

3 For a brief account of the first practical utilization of the trained 
visiting nurse for the care of the sick in their homes (William Rathbone 
in Liverpool, 1859, and the Woman's Branch of the New York City 
Mission, 1877) see "Visiting Nursing in the United States," Yssabella 




It is even said that the workers were not permitted to sit 
on their doorsteps in their shirt sleeves. 1 

Since 1842 we have traveled fast and far and bid fair to 
go at a still more rapid pace for some time to come. 

All through the history of industry we see the employer 
(or more frequently his wife or maiden sister) visiting sick 
workers and giving them advice or material relief, always 
with the idea of being charitable or philanthropic. By 
means of a kindly despotism these visits sometimes ac- 
complished much in family crises. In any case, the aid 
was usually welcomed as something received for nothing, 
but was often valued by the recipient at its apparent cost. 

This idea of the charitable employer clung to organized 
industrial welfare in its early days, hindered its develop- 
ment, caused much misunderstanding between capital and 
labor and was frequently the cause of discontent and ani- 
mosity toward the employer. 

The trained nurse probably first entered industry in 1895, 
when the Vermont Marble Company engaged a trained 
nurse 2 to visit the homes and care for the sick workers and 
their families. 

In 1897 the Cadbury Company (chocolate manufacturers) 
in England established a health department which has been 
extensively developed. The department now provides phy- 
sicians, trained nurses, masseuse, and convalescent homes. 
The account of these experiments is full of interest and will 
repay careful reading. Many dangers of paternalism seem 
to have been avoided, while the necessity of efficient medical 
and health supervision in any industry and especially in 
food industries is emphasized. 3 

In 1897 the benefit association of the employes of a large 
department store in New York employed a trained nurse 
to visit sick members and see that its funds were distributed 
fairly. It was thought that her nursing experience would 

1 Mrs. Gertrude Beekes Easley, National Civics Federation. A 
quotation from memory of a statement made by Mrs. Easley. 

2 Miss Ada M. Stewart. 

5 "Experiments in Industrial Welfare," Cadbury. 



enable her to do this work well and little or no consideration 
was given to her ability to be of help in any other way. The 
nurse employed 1 found that her nursing skill and ability to 
give health instruction and wise advice gained the confidence 
of those she visited and that only in a few cases was there 
any question of malingering. Of these, many proved on 
further study to be a real incapacity or a sincere but mistaken 
conviction of inability to work. Experience proved to her 
that her services could best be used by giving first aid where 
needed, by providing prompt and suitable medical and 
nursing care for the sick and injured, by following up the 
cases to see that medical orders were carried out, that the 
patients returned to their doctors when necessary, did not 
return to work before able to do so or while in a condition to 
be a menace to their associates, and that financial anxieties 
and family cares did not retard recovery. 

The field of the nurse in industry is still fundamentally the 
one discovered by this pioneer, with the broadening and de- 
velopment which accompany the growth of any agency meet- 
ing a distinct and long-felt need. The relationship in this 
instance between nurse and patient was particularly happy 
because the nurse received her salary from the funds of the 
benefit association. She was appointed by the elected rep- 
resentatives of the members and was really the employ6 
of the workers. When this arrangement exists it is possible 
for the nurse to make occasional visits solely for investiga- 
tion 2 as the workers recognize the justice of such visits 
and their necessity for the protection of their own funds. 
Under any other plan visits solely for investigation by the 
nurse are of more than doubtful value. Where, however, she 
is known to be ready to help and is sent in a helpful spirit this 
objection does not hold. 

About the time the trained nurse entered the field, far- 
sighted employers began to realize that certain forms of in- 

1 Miss Anna B. Duncan, R. N., former Secretary of The Benefit 
Association of the Employees of John Wanamaker, New York. 

2 See Chapter III. 



dustrial welfare and especially industrial nursing are "good 
business." The cost is now quite generally charged to over- 
head expense where formerly it was often charged to charity 
or occasionally even to advertising. This change of heart 
in the employer is nearly complete, but it sometimes remains 
for the nurse to do her part in bringing clearly before the 
employe" the motives and kindly aims of the company for 
which he works; a task which vanishes when the worker co- 
operates in establishing and managing the funds which pay 
the nurse and which provide his sick benefit. 

Various efforts have been made to solve the problem of the 
sick worker. It has often been a financial problem, but in 
these days of good wages it is frequently solely a question of 
educating the worker in the wise expenditure of a good income. 
With workers from many lands and from all parts of our own 
country gathered together in industrial centers, it becomes 
necessary for the far-sighted employer to do his part in mak- 
ing these heterogeneous elements into an American com- 
munity. This can best be done through the children in the 
schools and through the women in the homes. The industrial 
nurse, as well as other public health nurses, may assist in 
solving two problems: the making of good American citi- 
zens as well as the care of sick workers. She teaches the 
worker and his family in plant and home how to live in order 
to keep well and how to avail himself of proper medical care 
when sick or injured. She shows him that his fears of hos- 
pitals and doctors are groundless, persuades him to avoid 
quacks and patent medicines and points out to him the folly 
of depending on a kindly neighbor for gratuitous medical 

Efforts for the care of the sick worker are gradually de- 
veloping into the care of the well worker himself to keep him 
well, and into the care of his work rooms, house and com- 
munity conditions in order to keep him, and also his family, 
in good health. Development has been along three lines: 
funds organized and financed by the employer alone; those 
organized and financed by cooperation between employer 



and employe, each contributing a share of the cost and each 
having a voice in the administration; those organized and 
financed by the employes alone, either by the association 
of the employes of one plant (benefit associations) or by 
labor unions. The most acceptable to the self-respecting 
employe seem to be those funds to which he himself con- 
tributes and in whose management he has a voice, and those 
instituted by the employer as a definite part of his equip- 
ment, as necessary in the present state of society, as walls 
and a heating plant in our climate. 

It is not within the scope of tins book to discuss the rel- 
ative 1 merits of these different methods. While about four- 
fifths 2 of the states have provided by legislation for at least 
a part of the care and compensation of workers suffering 
industrial injury, none have provided state administered 
health insurance or pension systems in general industry. 3 
Until public opinion demands such legislation, employers 
and employes will continue in increasing numbers to pro- 
vide funds for these purposes. By means of experience so 
obtained the necessity of uniform laws and provision by the 
state for health insurance and old age pensions is being dem- 
onstrated. While these systems, as now maintained, solve 
many problems of the workers and assist the employer by 
reducing the labor turnover, they are often opposed by the 
workers. Employes so provided for often hesitate to take 
a more promising position with another company, knowing 
that by so doing they will lose claim to a pension and possibly 
to sick benefit. 

Accident and sick funds, as now administered, offer some 
of the following advantages : — 
1. First aid to the injured. 

1 " For Value Received, A Discussion of Industrial Pensions," by John 
A. Fitch, " The Survey," May 25th, 1918, Vol. 40, No. 8, p. 221. 

2 Statement from The American Association for Labor Legislation, 
131 E. 23rd St., N. Y. City, June, 1918. 

3 While Massachusetts permits savings banks to sell insurance, there 
is in this country no provision for general compulsory health insurance 
in any state. 



2. Accident compensation. 

3. Sickness compensation or health insurance. 

4. Pensions. 

5. Death benefits. 

6. Medical care. 

7. Nursing care in the plant. 

8. Nursing care for the worker in the home. 

9. Nursing care for the worker's family in the home. 

10. Hospital care for the worker. 

11. Hospital care for the worker's family. 

12. Special care for the tuberculous worker. 

13. Medical examination of workers. 

14. Periodical reexamination of workers. 

15. Sanitary inspection of plant. 

16. Sanitary inspection of homes when owned by the com- 


17. Loan funds. 

Maternity benefits 1 also have been paid to the mothers of 
legitimate children provided these women entered the plant 
at least one year before the birth of the baby and remained 
at home for a certain time before and after confinement. 

In addition to the above, provision is sometimes made for 
the services of dentist, chiropodist, masseuse and mani- 
cure, the latter specially in food industries. 

The entry of the nurse to the plant has usually been by 

1 Maternity benefits to women in industry deserve careful con- 
sideration. They tend to keep women at work who should be at home. 
They encourage the early weaning of infants. Even though receipt of 
maternity benefit requires that the woman should have entered the 
plant one year before the birth of her child and that she stop work two 
months before her confinement and remain at home six weeks after, 
she goes back to her work at the earliest possible moment, sometimes 
being forced to do so by her husband, both husband and wife fearing 
that she may lose a subsequent benefit at her next pregnancy. Women 
with several children have been proud to say that each baby brought 
them a benefit from their employer. They did not relate this seeming 
advantage to the doctor's, druggist's and undertaker's bills, which had 
been paid on account of these same children. Neither did they think 
of their unattractive homes, their hastily prepared food and possibly 
intemperate husbands or of their own weariness and poor health. 



way of the first aid room, but she has seldom stopped 
there. She soon found that the giving of first aid was 
one of the least of her duties, that it was only one of the 
many ways in which she found opportunities for service. 
Her value in industry, both to employer and to employe, 
steadily increased as she entered into the field of prevention. 

In the plant she was often able to discover cases of illness 
while in the first stages and still curable. This was most 
frequently true in tuberculosis. She was often the first 
person to observe the early symptoms and, while she, of 
course, made no diagnosis, the worker often accepted the 
nurse's statement that a thorough medical examination was 
wise. She found health and accident hazards and was able 
to secure their correction. She found daily opportunities 
for teaching the workers in matters of health and safety and 
in the necessity for early medical care and prompt first aid 
treatment. In the homes she was able to do all this and much 
more. There she found unlimited opportunity to make use of 
all she knew of housekeeping, dietetics, baby care and cook- 
ing. The growth of her work was only limited by time, by 
her strength and vision, and by the initiative allowed by 
her employer. 

Accident insurance, as in force in many states, has em- 
phasized the need of industrial nursing. Health insurance 
will open to ,the nurse a still broader field. As legislation 
for accident compensation has lessened the number of serious 
accidents 1 in industry while increasing the number of re- 
ported injuries, so health insurance, when it comes, will 
lessen the total of industrial disease and other illness while 
probably greatly increasing the number of persons under 
medical care. As the industrial nurse has been found in- 
dispensable in caring for accidents and in their prevention, 
so will the demand for her services increase as health insur- 
ance for the worker, whether provided by the employer, by 

12 Mrs. Florence Kelley of the National Consumers' League has been 
heard to say that the only industrial accident is for a man to be struck 
by lightning while at work and that all other so-called industrial 
accidents are preventable injuries. 



the worker, by both together, or by the state with a tax on 
both employer and worker, becomes general. 

Whatever the final settlement of industrial problems, the 
nurse cannot be spared from industry. When capital and 
labor have learned that cooperation and mutual understand- 
ing are essential to human welfare, she will reach her full 
usefulness. She will continue to serve employer, worker and 
community as long as workers suffer accident or illness and 
while the laws of health are unknown or disregarded in 
plant, home or neighborhood. 



It is safe to say that most industrial nurses now in the field 
are still pioneers. There are, as yet, no fixed standards of 
work and few have had training for this particular branch of 
public health nursing. The nursing profession finds itself 
in the uncomfortable position of trying to meet the call for 
specialized workers, with few to respond. Many are being 
equipped in the school of experience but not in sufficient 
numbers to meet the demands of our present industrial 
development. It is an encouraging sign of the times, how- 
ever, that schools for nurses and colleges are beginning 
to offer courses in preparation for industrial as well as other 
forms of public health nursing. 

In the past the industrial nurse has been obliged to get the 
special education she needed after entering the work. While 
any nurse must always continue to increase her knowledge 
and ability in any position, the first steps will be easier if she 
already knows a little of what may be expected of her, under- 
stands something of industrial conditions and has an idea 
of mistakes to be avoided. If, in addition to this, she is an 
all round public health nurse she will be able to see and act 
quickly upon opportunities for service and work with a sure- 
ness and confidence which will come more slowly to the self- 
trained pioneer. 

The time is past or passing when the employer asks solely 
for "a nice, motherly woman" as industrial nurse. He now 
more often says, "We need this work and want it started 
properly. Send us a well-equipped, experienced person." 
He looks to the nurse for real help in his problems and less 
often thinks of her only as an almoner, a detective, or merely 




as an assistant to the company doctor. He frequently re- 
quires some one who can be of intelligent assistance to the 
company doctor, the employment manager, the sanitary 
engineer and the statistical department; some one who is 
able to cooperate with all departments of the plant and with 
local public health agencies. In plants where numerous 
divisions of responsibility do not exist, he sometimes expects 
her to take upon her shoulders work which is not exactly 
nursing but which is of such a nature as to aid in the pre- 
vention of illness and accident. These additional duties are 
quite within a nurse's province. All progressive social 
agencies aim to work steadily for the elimination of the need 
for their services. The medical profession is interesting it- 
self more and more in prevention and so partially doing away 
with the need of treatment. Industrial nurses, as assistants 
to the medical profession, as public health workers and as 
social workers must aim in every possible way towards the 
time, foretold by Florence Nightingale, when nurses in gen- 
eral will become health nurses instead of sick nurses. 

In addition to a "sick" nurse and a "health" nurse, the 
worker needs a friend, who holds his confidence, and who, 
on this account, is able to interpret to him the good will of 
his employer. A friend who has the sympathy and clear 
insight into his needs which will enable her to act as his un- 
official representative and interpret him to his employer. 

In short, industry needs a good nurse with a knowledge of 
methods of social work in addition to familiarity with meth- 
ods of public health nursing. 

Industrial nursing must often be accomplished happily in 
surroundings not ideal. As conditions change, the nurse 
must be ready to develop new methods to meet them. If she 
loves her work, she will always see more to do than her em- 
ployer has planned for her. 

To meet all these needs of industry, the nurse must have a 
healthy, vigorous body, an understanding mind and an 
adaptable disposition. Only so endowed, by nature or dis- 
cipline, will she be able to keep her courage, youth and zeal. 


Industry has no place for the half-trained woman unless she 
is to be confined within the four walls of a first aid room and 
even there she is a potential source of danger. 

The advantages of a liberal education before hospital 
training need no argument. The nurse's training school 
* should give her the theory and practice of first aid and 
operating room technique, of obstetrics, baby feeding and 
dietetics as a part of the required course of study. In the 
third year of training or as a postgraduate course, the pupil 
should get an insight into public health nursing in an in- 
structive visiting nurse association or nursing settlement. 
This should give her an idea of sanitary inspection, anti- 
tuberculosis propaganda, prevention of blindness, early de- 
tection of cancer, prenatal and baby welfare work and 
school nursing in addition to bedside nursing in the homes of 
the people. 

Either during her preliminary education, hospital training 
or postgraduate work, the nurse should get a working knowl- 
edge of psychology and of civic, industrial, social and relief 

The writer has known the necessity for a knowledge of 
family budget making, for skill in buying, planning and cook- 
ing well-balanced family meals, for ability to devise suitable 
menus for workers' lunch rooms, for a facility in house- 
keeping, gardening, sewing, and running an automobile, all 
in addition to well-defined nursing duties. Experience in 
organizing clubs and recreations has been found useful by 
other industrial nurses. Ability to speak in public and to 
teach will add to efficiency. 

Familiarity with the language of the workers will often save 
the day in a difficult situation. Even one word of a sick 
man's own tongue makes him feel that he is with friends. 
With slight effort, any one can learn a few useful words and 
phrases as they are needed. Where the workers are largely 
of one nationality, a little regular study and the available 
daily practice gives a fair working knowledge of their lan- 
guage in a short time. In a little Polish settlement the one 



word (dobra — good) proved a good beginning for public 
health work. Later, with an interpreter, prenatal hygiene, 
baby feeding and bedside nursing were successfully taught. A 
few new words were acquired at each visit without any effort 
at study and with spelling entirely phonetic. Every one was 
anxious to teach his own tongue. No one was critical. A few 
words, accompanied by smiles and enthusiastic gestures, got 
the idea "across" even though the rules of grammar were 
disregarded. Miss Lillian D. Wald, author of "The House on 
Henry Street" has said that, though a knowledge of the 
language is important, the patient's conviction of sympathy 
on the part of the nurse transcends that. She rejoiced that, 
though she could not speak all the languages, she could smile 
in twenty-seven different dialects. 

The trained nurse considering service in industry should 
question herself carefully before deciding to enter the work. 
Is she really democratic? Will she be willing to remember 
that she is a fellow worker and a neighbor as well as a friend 
and counselor? Will she work, not so much for industry as in 
industry and not so much for the employer and the worker as 
with and through them? Does she like people so well that 
she will listen willingly to their familiar gossip, and so in this 
way understand their own wishes and what they recognize as 
their own needs before she tries to lead them? 

While a nurse is not expected to have any great knowl- 
edge of industrial disease, intelligent work demands some 
familiarity with the subject and especially with the dis- 
eases incident to the particular industry in which she is 

The proper handling of the daily problems often depends 
on ready familiarity with all provisions existing in com- 
munity, state and nation for the care of the sick or for the 
education of the public in matters of health and safety. 

The necessity of constant stimulus to renewed effort, 
obtainable by reading and study, is evident. Attendance at 
meetings of the National Organization for Public Health 
Nursing, the National Safety Council and frequent contact 


with other nurses doing similar work make for increased 
interest, enthusiasm and ability. 

Practical experience or even observation visits for nurses in 
training are hard to arrange. Until nurses already in the 
field and their employers are more ready to give students 
these advantages, dependence for practical experience must 
be placed on a period of service as assistant in a well-organized 
industrial nursing department. Such an apprenticeship, 
in any case, is the best possible preparation for undertaking 
alone the management of such a department. 

All work for social and industrial progress will be advanced 
by a supply of nurses, fitted for the service, in sufficient 
numbers to meet the demands of industry. 



In her book "Public Health Nursing," 1 Miss Mary S. 
Gardner lays down eight fundamental principles of public 
health nursing: 

"1. That only well-trained nurses should be employed. 

"2. That the nurses should not be the distributors of 
material relief. 

"3. That there should be no interference with the religious 
views of the patients. 

"4. That the rules of professional etiquette should be 
rigidly observed. 

"5. That cooperation in all its forms should be recognized 
as of primary importance. 

"6. That suitable and accurate records should be kept. 

"7. That patients unable to pay for nursing care should 
receive free service, and that those able to pay for it should 
do so according to their means. 

"8. That the daily working hours of the nurses should be 
limited, in order that good work may be done and they them- 
selves be kept physically fit." 

Industrial nursing is public health nursing with additional 
responsibilities, different surroundings, and perhaps, in some 
ways, more strict limitations. No one will dispute that 
1, 3, 4, 5, 6 and 8 apply with equal force to industrial and 
other forms of public health nursing. Any one in doubt on 
the subject is advised to read Chapter II of Part I of Miss 
Gardner's book. There remain then 2 and 7. We will en- 
deavor to show that, while an industrial nurse may find it 
necessary to dispense material relief, the arguments against 

1 " Public Health Nursing," Miss Mary S. Gardner, page 55. 



the practice are even stronger in her case than in others and 
only when no other course is open should she have recourse to 
it. The industrial nurse is not in any sense a charity worker. 
She is employed as a part of a regular provision for the well- 
being and efficiency of the workers. If she allows herself to 
be the means of bringing in charity, she destroys her best 
hold on those she serves. If she allows herself to be anything 
but a helpful friend who is also a coworker, she will lose much 
of her influence with her patients. They will soon forget the 
nursing care, helpful advice and teaching if they find that 
gifts of material value are obtainable through the nurse. It is 
only human to value tangible above intangible benefits. Of 
course the workers of a better and more independent spirit 
will not wish charity, and, in the long run with all, the nurse 
will gain nothing by a relation which permits any other inter- 
pretation than that of being considered one of the generally 
accepted and universally welcomed provisions for industrial 
safety, health and happiness. 

Of course no nurse will allow a patient to suffer for the lack 
of help. Some means will be devised. The self-respecting 
worker appreciates a loan fund, maintained by the com- 
pany, by the workers, or by both together, from which sums 
may be borrowed in time of need and repaid when the 
emergency is over. Where there is such a fund, there is no 
objection to the delivery of borrowed sums by the nurse. 
Neither can any harm come from the nurse taking to the 
patient any regular income such as a salary allowance or a 
sick benefit. In fact she should not forget the possibility of 
such relief being available and she should do all she can to 
secure its prompt and regular payment. One of the best aids 
in preventing the demoralizing influences of physical mis- 
fortune is the continuation of some sort of regular income on 
which dependence may be placed and with which plans may 
be made. If the employer, benefit association or other in- 
dustrial relief organization takes no responsibility, as in the 
case of a new worker, it may be necessary to refer the sick 
person or his family to a local relief agency or even to town or 



county poor officers. In no case should this be done without 
the consent of the person concerned or without the sanction 
of the person in charge of such matters at the plant or in the 
office of the industrial relief organization, if such exists. 

A nurse often lacks the social training to enable her to give 
relief wisely and, even with the training, her time may usually 
be better occupied if she can find an expert for this difficult, 
specialized work. 

We may usually omit the question of pay for services from 
the problems of the industrial nurse. If the nurse is em- 
ployed by the company, it is as a worker whose services are 
necessary to the efficiency of the other workers and each 
one should feel as free to seek all the help she is allowed to 
give as he would be to send for a specialist to make repairs 
on the machinery. When, as sometimes happens, the indus- 
trial nurse cooperates with the local visiting nurse association 
for the nursing care she has not the time to give regularly, the 
question of proper payment to the association must not be 
forgotten. If the employer is willing to assume the cost of 
such visits, a report should be made of each case attended and 
a weekly or monthly summary of visits should be submitted. 
If there is no such arrangement, the nurse will carefully ex- 
plain to the worker the difference between the way in which 
she comes to him and the means by which the services of a 
visiting nurse are made available to the community. When 
he understands the method of support of the visiting nurse 
association, he will usually, if able, be glad to pay according 
to his means. In case he is unable to pay, a word with the 
superintendent of the association will undoubtedly place him 
on the same footing as others in need of nursing care. 

A ninth principle should be included for the industrial 
nurse. She should not be a detective. She is useless in any 
capacity but that of an intimate, confidential friend and 
teacher. In industrial establishments, there are persons who 
may think their aims will be furthered and their departments, 
or the organization as a whole, strengthened by utilizing the 
nurse in such errands as finding out the whereabouts of a 


worker, whether he is drunk, etc. The nurse will do well to 
nip such tendencies in the bud. She should make it clear 
that she visits the worker only to be of service to him. If she 
keeps this in mind, she may be able to help the man she finds 
intoxicated and the girl who has gone to the picture show 
when her mother thought she was at work. There are few 
calls that a nurse may not advantageously answer if she 
remembers that she is not a detective, and if she impresses 
every one with whom she comes in contact with the right 
conception of her work. She may acceptably visit any one 
at any time if she is sent in a helpful spirit, but without this 
purpose she cannot be expected to pry into the affairs of 

In cases where malingering is suspected, the nurse has no 
responsibility at all. It is a physician's business to make the 
diagnosis of malingering as well as all other diagnoses. The 
nurse's duty ends when she has relieved discomfort, carried 
out the physician's orders for treatment and stated to him 
any symptoms she may have observed. The question of 
malingering is a very small one. Many cases of supposed 
malingering prove later to have been obscure conditions 
often more serious and harder to cure than something which 
was at once self-evident. Tactful treatment by the nurse will 
sometimes bring the diagnosed malingerer back to work and 
will do much in those not infrequent cases where the patient 
needs to be convinced that it will not hurt him to take up 
work again. 



The scope of the industrial nurse's activities is almost as 
varied as industry itself. It ranges all the way from definite, 
limited nursing duties, as part of a large welfare department 
under a welfare director, and with the health department in 
charge of a physician, to duties which include the supervision 
of all the welfare work done in the plant. 

Large concerns often devote great sums of money to ex- 
tensive work for the betterment of industrial conditions and 
the welfare of the workers and, in such an organization, the 
nurse may find little work for which she has not been prepared 
by her training in hospital and public health nursing. If there 
is but one nurse, her duties may be only those of a nurse, 
there being other trained workers in the plant with whom to 
cooperate for the full welfare of her patients. If she has the 
supervision of other nurses she will have, in addition, the 
duties of an executive. She may also have clerks, cleaners and 
other workers on her staff. She often begins as the only nurse, 
being given additional help as she develops her work and 
proves the necessity of assistance. There is much to be said 
in favor of this slow growth either in a large or a small plant. 
Many mistakes are avoided and the nursing department is 
better adjusted to the particular needs of the industry. 

A welfare superintendent, who may be a nurse, often has 
general supervision of the employment department, sanita- 
tion of the plant and tenements of the company, pensions, 
compensation, sick benefits, material relief to workers in 
financial difficulties, care of industrial injuries, care of sick, 
education, recreation, etc. According to the size of the 
plant, there may be, as assistants or co-workers, a number of 
other trained workers. There will be a physician. A social 



worker, a sanitary and safety engineer, a dietitian, club 
managers and other specialists, as well as a nurse, may also 
be on the staff. 

It is not necessary to go into the. organization of industries 
further than to show the nurse, whose experiences may have 
been along other lines, some of the conditions under which 
she may be expected to woik. The questions of management 
are handled in almost as many ways as there are kinds of 
industry. The nurse need not trouble hei-self with these 
problems except as they affect her efficiency. 

In some industries the nurse may be employed and paid 
by the workers themselves through benefit associations, or 
other organizations of workers. This arrangement has many 
advantages. The friendly understanding between patient 
and nurse is prearranged. The help of the nurse comes as 
something the patient has paid for and he values it accord- 
ingly. However, any nurse, no matter how paid, will have 
no difficulty in gaining the confidence of those she serves, if 
she has an unselfish desire to help them. 

In those industries where the employes have a voice in 
making the plans for their own welfare, the nurse is often 
responsible to a committee of workers. This necessitates 
regular meetings which should be welcomed by the nurse. 
Not only will she have stated times for explaining what she is 
doing and what she would like to do, but she will have a price- 
less opportunity for the advancement of her own industrial 
education. The members of the committee will be able to 
explain local prejudice and customs, assist the nmse in her 
study of industrial hazards, and as representative employes, 
give to her efforts a backing hard to equal. The question of 
material relief is sometimes undertaken by the members 
through these officers, much to the satisfaction of the un- 
fortunate but self-respecting worker. Here the nurse should 
keep her hands off where possible, only acting in an advisory 
capacity, and allowing the actual aid, unless a regular allow- 
ance, to come through some other medium. 

Another means of helpful conference is to be found in the 



regular meetings of department heads, foremen, safety ex- 
perts, and others, which are a feature in the management of 
some plants. Here problems which touch more than one 
department are discussed and plans are made by which the 
work of the plant may be carried on with the least possible 
overlapping and friction. 

Other firms place the consideration of all questions of 
detail in the hands of the chief executive. Each method has 
advantages. The nurse must be able to reach the ear of the 
committee, or the executive, or the member of the firm 
having power to act in behalf of her work. She will soon 
learn the wisdom of presenting facts rather than surmises to 
busy people and will have them carefully written out to- 
gether with definite suggestions. 

The industrial nurse cannot reorganize the industry to suit 
her convenience, and any plans she may have for the better- 
ment of her work should have the careful consideration of 
herself and of her associates before being placed before an 
executive meeting, or a busy general manager, or a harassed 

The nurse will learn much from her associates. It is true 
that they may also learn from her, but her popularity will not 
suffer by suppressing in her dealings with her co-workers her 
desire to teach. She will best obtain their liking, respect, and 
cooperation by showing plainly that she has no wish either 
to do their work or to show them how to do it, that she is a 
nurse first and that if she attempts other work it is only 
because, at the time, there is no one else who is better fitted 
to carry it through. 

This is a good opportunity to say that the nurse should be 
very sure, before undertaking any work outside the bound- 
aries of public health nursing, that no other available worker 
is better equipped for its successful accomplishment. 

In a small plant or in one with a smaller welfare depart- 
ment, the nurse's duties may have a wide range. In general 
she should be willing and, in a measure prepared, to do what- 
ever needs to be done. She should even study the question of 


administering material relief wisely. Her usefulness may, at 
some time, depend on this preparation. 

The industrial nurse in the small plant is apt to be allowed 
a good deal of initiative. She comes in closer touch with her 
employer, who is often the owner of the plant and who may 
also be a worker in it. He becomes familiar with her abilities 
and is more ready to take advantage of her help in varied 
problems than the employer in a larger plant who may 
seldom or never see the nurse. Her work should be such as 
to show the value or necessity of each step she takes and she 
should take care not to waste her time, which is her em- 
ployer's, in experimentation and random efforts. Her rec- 
ords and reports will help her to avoid these difficulties. 

The company doctor, at least in states having compensa- 
tion laws, attends all industrial injuries requiring surgical 
care. Some firms make provision also for the medical care 
of the workers, and even in some cases for the care of the 
families as well. Benefit associations and mutual aid societies 
frequently make such provision and some labor unions as 
well. Industrial diseases have been construed by courts in 
some states as coming under the same compensation rulings 
as injuries of a violent nature and many firms so treat them 
without legal compulsion. 

Different arrangements are made by many firms for the 
medical attention required by law. In small towns, where 
the industry is the reason for the existence of the community, 
the company will often maintain a hospital for its workers 
and their families. The industrial nurse may have charge of 
such a hospital. Where a general hospital, even though in a 
neighboring town, is available, many employers do not wish 
the responsibility of maintaining their own hospitals. They 
consider, rightly, that the seriously injured worker will be 
more apt to receive the best attention in an institution where 
the foremost specialists of the locality are on the staff. 

Certain firms employ a physician for a stated number of 
hours daily, or at other regular intervals. In other plants, 
one or more local doctors respond to calls when needed. 



Occasionally all the doctors in town are employed, the patient 
being free to choose among them. 

The good custom of employing the full-time services of a 
physician is growing. In large establishments, several doc- 
tors may be employed, together with eye, ear, nose and 
throat, and other specialists, dentists and even chiropodists. 
In addition to the surgical and medical care of the workers 
in the plant, and possibly in the homes, many firms require 
the physical examination of all new workers and sometimes 
the reexamination, periodically, of all employes.^ 

Contrary to common opinion, these examinations are 
seldom for the purpose of excluding the handicapped, except 
where there is danger of contagion to fellow workers or of 
contamination of product. The usual aim is to prevent 
employment in an occupation dangerous to the employe's 
well-being. The reexaminations make possible the transfer 
of those requiring it to more suitable work. They also dis- 
cover many diseases in the early stages, while still curable, 
frequently before the worker is aware of his condition. Half- 
sick workers, discovered in this way, are often treated in the 
works dispensary or sent to private physicians for conditions 
which may be controlled in the beginning without loss of time 
or with a short rest, but which, if neglected, might easily 
prevent all work or even prove fatal. The average worker 
without medical supervision will endure what seems to him a 
slight illness until his misery forces him to go to a doctor. 
The aim of most firms is not to interfere with the private 
practice of local physicians, but to coopeiate with them in 
raising the health standard of the community. 

In plants where the examination of employes is in the 
hands of physicians connected with organizations of workers, 
such as mutual benefit associations or labor unions, there 
seems to be little opposition to these examinations on the 
part of those benefited by them. 1 

1 For interesting discussion of this subject, see "Physical Examina- 
tion of Employes," John B. Andrews, Secretary, American Association 
for Labor Legislation. 


"Furthermore, the workmen's present objections to med- 
ical examinations conducted by physicians hired by em- 
ployers would disappear when the examinations were under- 
taken by a staff of physicians employed by insurance funds. 
The loss of employment on account of ill health will be more 
than counterbalanced by the opportunities for quick recovery 
when every worker suspended on account of physical un- 
fitness will be entitled to sick benefit administered, not by the 
employer and his hired physician alone, but by representa- 
tives of employer, employe and state." 1 

An industrial physician for a large plant has repeatedly 
stated to the writer that the nurses were invaluable in ex- 
plaining to the workers the real purpose of the physical 
examinations required by the company and in getting them 
to submit gladly. They have also succeeded in getting 
many patients to come voluntarily for reexamination. The 
nurses in this plant had been employed before the physician. 
They had demonstrated that a full-time physician was a 
necessity and their recommendations carried great weight 
in the decision to employ one. 

The question of cooperation between the full-time com- 
pany doctor and the industrial nurse is usually solved by the 
observance of customary professional etiquette. 2 

Many plants, however, cannot have the full-time service 
of a doctor. Unfortunately some firms have even considered 
they had done all that was necessary in engaging a nurse and, 
most unhappily a nurse has, in a few cases, taken a position 
where there was no physician, even nominally, in charge 
of the medical and surgical work in the plant. This has done 
harm by creating a misconception of industrial nursing in the 
minds of physicians and in overemphasizing to the worker 
the importance of the nurse from a medical standpoint. It 
seems doubtful if, at the present time, any nurses of good 

1 "Physical Examination of Employes," John B. Andrews, Secretary, 
American Association for Labor Legislation. 

2 The whole subject of professional etiquette is treated fully and 
beautifully by Miss Mary S. Gardner in her "Public Health Nursing," 
Part I, Chapter III. 



standing are working in industrial first aid rooms without a 
physician to diagnose, to direct the treatment of cases and to 
supply standing orders for use in his absence. Even small 
employers are realizing the limitations of the nurse and are 
availing themselves, in addition, of the services of physicians 
at least for part of the time. 

The doctor and nurse each has a place in industry and the 
nurse should no more be expected to usurp the doctor's 
office than the doctor should be expected to do the nurse's 

Owing to the lax standards which have occasionally existed 
in the past, industrial nurses should be more careful than 
others to avoid even the appearance of giving medical or 
surgical care without the supervision of a physician. When 
giving treatment in the absence of the physician, the nurse 
should explain to the patient from time to time that the 
dressing or special treatment is given because it has been 
ordered by the doctor in charge. Patients, ignorant of pro- 
fessional etiquette, often cause misunderstanding of the 
nurse by boasting of her cleverness and declaring that she 
knows more than most doctors. Even though this is an ex- 
pression of gratitude, it must not be allowed. The tendency 
can best be overcome by seeming to ignore it and by carrying 
on a continuous campaign of education. It is also well to 
explain incidentally the legal side of the question. 

The part-time company doctor has sometimes been known 
to present a problem in accomplishing good team work, which 
may be traced to the financial arrangements made with him 
by the company. Where the part-time physician has a stated 
salary, calls at the plant daily or at other regular times, 
responds to emergency calls and attends patients who may 
be referred to him, a capable nurse has little difficulty in 
obtaining his support and cordial cooperation. On the other 
hand, where the physician is paid according to the number of 
dressings done or patients seen, he occasionally feels, and 
indeed has been known to say frankly, that the nurse at the 
plant was taking money out of his pocket. Perhaps she was. 


This is an indication for better arrangements with the doc- 
tor — not for dispensing with the nurse. 

By giving prompt first aid and by getting patients to the 
doctor in time, the industrial nurse can prevent numberless 
infections. Consequently much money is saved to the com- 
pany which would otherwise be spent for the surgical care of 
the workers. 

On the other hand, by finding patients in need of medical 
attention, she increases the number of his interesting cases 
and gets many patients under the physician's care while 
something can be done for them, thus helping to increase 
the value of the doctors to the community. Workers speak 
willingly to a nurse, who is their friend, about conditions 
which would not otherwise be brought to a doctor's attention 
so soon. The nurse, in her daily contact with the workers, 
has the best of opportunities to observe those in need of 
medical care and she can usually persuade them to see a 

While the nurse is careful to make no diagnosis, to recom- 
mend no particular physician and never to advise a change 
of doctors, the company physician, together with all the 
other physicians in the community, gets a larger number of 
curable patients and has a better chance to show the value of 
expert medical and surgical care than where no nurse is 

The condition just described is more typical of a small town 
than of a large city but the difference is only that, in a large 
city, the nurse's work, being spread over so great a surface, 
is less apt to attract attention and comment. 

The majority of physicians are far above such petty con- 
siderations and are too busy with important things to give 
them a thought. 

Some firms employ two or more doctors, allowing the in- 
jured worker to have his choice, the doctor chosen coming 
to the plant, or seeing the patient in his office or in the pa- 
tient's home, the exact arrangement often being left to the 
judgment of the nurse. 



The employment of several different and not always like 
minded physicians complicates matters for the nurse. Her 
salvation lies in the cooperation of each doctor with all the 
other doctors and with her. Standing orders must be ob- 
tained for the nurse and they must be signed by all the doc- 
tors who are employed by the company to attend industrial 
injuries. This is a difficult thing for the nurse to attempt 
and may better be done for her by the employer. In one 
instance, where the first aid methods of the three doctors 
employed vaiied, an employer submitted to them a first 
aid pamphlet published by a large safety organization. This 
was only intended as an illustration of something simple, 
safe and practical. It was, with a few additions, approved by 
the doctors. The nurse was then able to give first aid and 
to teach it to the workers, feeling that she had the support 
of all the doctors employed by the company. Previously 
she had tried to work with three sets of standing orders and 
the resulting complications. Fortunately no one died, not 
even the nurse, but harmony did not exist until there was one 
set of standing orders approved by all three doctors. 

To the greater number of industrial physicians, the nurse 
has only to prove her honesty of purpose and her ability to 
help them and their patients, to be accorded hearty co- 
operation and support. Sometimes this is slow of accom- 
plishment but, where the aims and ideals of both are the 
same, it will come in time. 

The cooperation of the other employes is as necessary as 
that of the physician and other welfare workers. A first 
aid room or dispensary is of little use if the worker does 
not realize the importance of having all injuries treated. 
A doctor's visit is a waste of money if the patient does not 
do as he is advised. Safety devices are of no value when 
out of order or unused. The nurse must devise means for 
bringing these and other matters before the workers. This 
question will be taken up more fully later. 

If the first aid room is made democratic by the impartial 
treatment of all workers, its popularity and value are in- 


creased. In some plants, all persons connected with the 
establishment, employers, managers, office boys and scrub 
women are treated, when necessary, in the first aid room 
and even at times in their own homes by the visiting nurse. 
This policy places the medical or nursing department plainly 
in the minds of all as a necessary department of the plant 
and not as a charity. 

The industrial nurse cannot reach her full usefulness with- 
out the cooperation of each and every person in the plant, 
but if this ideal is not attained at once the nurse must neither 
grow discouraged nor abandon her efforts. 

It will never help matters to take sides in any labor dis- 
turbances or in any disagreements between various factions 
in the organization. The nurse should not discuss such sub- 
jects and should keep her personal opinions to herself. Her 
duty is to serve both sides to the best of her ability. Loyalty 
to her employer and to her patients may require her to in- 
terpret one to the other but she should be neutral, although 
helpful in promoting peace and good feeling. Where the 
nurse does not feel real loyalty to her employer, she will 
surely be more useful in some other field of effort. 

Even more important than gaining of cooperation is giving 
it. To be able to cooperate, we must see things through the 
eyes of others. We must gain an insight into the character 
of people, their early environment, their habits and super- 
stitions, their present surroundings, their abilities and op- 
portunities, their interests, hopes and ambitions. 



The importance of the industrial nurse as a factor in the 
community will depend first on herself and second on the 
initiative allowed her by her employers. In any case it will 
be a matter for slow and conservative advance with strict 
observation of the wishes of the employer. 

The nurse should make it one of her first duties to discover 
all the resources of the community which may aid her in her 
work. She should compile a directory, if one is not published 
by an organization, containing the names, addresses, tele- 
phone numbers of health and poor officers, physicians, dis- 
pensaries, hospitals, lodges, charity organizations, baby 
welfare agencies, churches, clergymen, reliable housing, 
rooming and boarding agencies, etc., and any special informa- 
tion concerning them. In a large city such a directory may 
often be obtained from the charity organization society. 
Whether working solely in the plant or in the homes as well, 
the nurse will have frequent need of information from some 
of these sources. 

Through her employer, the nurse may become an important 
factor in the general community welfare. 

In a small plant known to the writer, the nurse busies her- 
self with all sorts of civic problems. Through her employer 
and with the cooperation of the health department and the 
transportation company, she has been able to secure shorter 
headway between cars during rush hours, thus avoiding 
needless exposure of workers and much consequent illness. 
Through her influence, a shelter has been built at the trolley 
station. The abatement of industrial nuisances, such as 
smoke and fumes from neighboring plants, was secured by 



proving to the employer the harm they were doing his work- 
ers. A letter to the owners of the offending property from 
the nurse's employer was followed by consultation with 
state and federal health officials. With the advice of these 
experts, proper consumers and chimneys were constructed. 
This nurse is now arousing interest in an evening dispensary 
where workers may secure medical care and pay for it. In 
her small plant, she has time for many things which might 
not be advisable, even if possible, for the nurse in a larger 

It is possible for industrial visiting nursing in a small 
community to be done in such a way as to stimulate a desire 
for a like service for all classes of the population, and to 
lead to the formation of a visiting nurse association or even 
to visiting nursing under the board of health. Baby welfare 
work and prenatal care may be quietly initiated in the same 

The industrial nurse will, at least, be able to show what 
good nursing is and to set a standard for such work which 
will do much to prevent the employment in positions of re- 
sponsibility of untrained or half -trained women. 

An industrial nurse, living among the workers in a house 1 
provided by her employer, has a unique opportunity for 
service. At the house she may hold prenatal classes, baby 
welfare conferences, little mothers' classes, and even teach 
cooking, sewing and English. In a small town, the house, 
while serving as a community center, would furnish a prac- 
tical and simple example of comfortable furnishing and the 
garden could be used to stimulate the enthusiasm and com- 
petition of the neighbors. 

Even though the industrial nurse finds no opportunity to 
do any of the big things, she must not fail to be a good neigh- 
bor as well as a good citizen. 

But if her employer allows her a reasonable amount of 
initiative, and if she also has his close and interested co- 
operation, she should be a strong factor in stirring up com- 
1 See Chapter XII, The Industrial Nursing Center. 



munity interest and in keeping it fixed on the common com- 
munity problems and should be able to assist in the solution 
of many community difficulties. In a small town, she should 
find it possible to demonstrate the need of prenatal, infant 
and child welfare work and school nursing; she should be 
capable of giving reasons for an increase of local hospital 
facilities, especially for the care of tuberculous patients, 
contagious cases and those self-respecting people, forming 
the majority of most communities, who are not objects of 
charity, but who, when sick, need care as much as the charity 
cases and as much as the richer members of society. These 
are the people who are able to pay the actual cost of comfor- 
table care, but who find the prices of the private patients' 
department of a hospital prohibitive, or such a tax on future 
earnings that much actual harm is often done the patient by 
the worries he cannot escape. 

Until slowly awakening public opinion writes health in- 
surance into the laws of all the states of the union, the prob- 
lems of this middle class (made up of most of us) will need 
the thought of each person who may be able to help in any 
way, however small. 

The industrial nurse cannot escape being a factor in the 
development of good laws and in the furtherance of health 
insurance because she unconsciously influences so many 
people. She teaches the money value of health and dem- 
onstrates by actual facts to her employer, as well as to the 
worker, the benefit of even a little attention to its preserva- 

In exerting an unobtrusive influence in the community and 
in finding out the needs and the wishes of the people, a wide 
variety of contacts is of the greatest help. The industrial 
nurse who can possibly find the time will learn many things 
by taking into her life as much as she can of the social life 
of the town. If there is a woman's club, a civic association, 
a community council or any organization which should be 
in touch with local questions, the nurse may gain much by 
becoming a member and by taking an active part in bringing 


matters before the organization, in getting them discussed 
from all points of view and in preventing important questions 
being "laid on the table" because no one has the courage to 
tackle them. 

Sometimes a word to the right person will start the ball 
rolling and no further action on the part of the nurse is 
necessary. If the person initiating the movement can be 
placed in the agreeable position of having thought of the 
need himself, so much the better. 

We must not forget that we cannot move people along the 
road of progress one bit faster than they see the need of being 
moved. We must remember that the best and most pro- 
ductive efforts for the improvement of any group have always 
had their origin within that group. Individuals, each one 
working for his own good and for that of his fellows, are 
happier and better people than the same persons treated as a 

So nurses, as individuals, working with and through those 
with whom they come in contact, rather than for them, 
cannot fail to further to some extent, public welfare and 
democratic ideals as well as public health. 



The employer often engages a nurse with the idea that she 
will be responsible for the first aid room and with little 
thought of any further development of her work. He will 
sometimes tell her that the number of industrial injuries 
is small, perhaps as few as an average of one a week. Of 
course he believes this to be true but inquiry will usually 
reveal that no thought has been given to the scratches, small 
punctures, cuts, splinters, burns, etc., which, without a 
nurse's presence would have no care, other than possibly 
that of the unskilled fellow worker, unless serious conse- 
quences developed. It will also be found that injuries of this 
class, where existing records make a distinction possible, 
often cause a larger total surgical expense, a greater loss of 
time from work and more annoyance in the settlement of 
claims than all other kinds of industrial disability. 

The first result noticeable, after the establishment of an 
efficient first aid service, is a tremendous increase in the 
number of reported injuries, followed at once by a marked 
decrease in the number of infections and of belated claims 
for compensation, together with an appreciable reduction 
in the expenditure for the care of such cases. These later 
results are just what the employer wants, but he may find 
it hard to reconcile the apparent increase in the numbers of 
those injured until he realizes that the desirable results are 
only to be accomplished by this means. "No break in the 
skin is too small for first aid," should be the slogan. 

The foremost requirement for an efficient, or even a legal, 
first aid room in an industrial establishment is a physician 
employed by the company to care for the cases of serious 




industrial injury and to direct the treatment of the small in- 
juries which require little more than first aid care. No nurse, 
who values her professional standing, will consent to carry 
on such work where there is no doctor to assume the moral 
and legal responsibility of medical and surgical treatment and 
to direct the nurse in her care of minor injuries and ailments. 

A physician, devoting a limited time to the needs of an in- 
dustry, sometimes asks a nurse what standing orders she 
requires. In such a case she should suggest as simple and 
limited a list as possible, including the care of small breaks 
in the skin, burns, contusions and any special small injuries 
peculiar to the industry. The latitude allowed the nurse 
in giving medicines should be rather less than that often 
permitted by the average physician accustomed to working 
with trained nurses. 

After the nurse has obtained standing orders, she must 
make it plain that she uses them. Lacking the right relation 
between the doctor and the nurse, the patient is sure to 
suffer from want of confidence, the physician will not have 
the nursing assistance he has a right to expect, the company 
will be annoyed by a department that does not run smoothly, 
and the nurse will be sure to suffer numberless misunder- 
standings and discouragements and may even find her posi- 
tion untenable. 

Special thought should be given to the matter in those 
plants employing two or more local doctors as described in 
Chapter IV. 

On beginning industrial nursing in a plant, with only part- 
time service from a doctor and where no such work has been 
done before, the nurse should lose no time in making herself 
familiar with her surroundings. If actual nursing can be 
postponed for a week or so, everything being allowed to go 
on according to custom, the nurse will be able to see how 
much of the old may safely be preserved and what immediate 
changes are necessary. To this end she may request the 
management to allow some one, thoroughly familiar with 
every part of the plant, to accompany her on a tour of in- 



spection. In this way she can meet the various heads of 
departments and the foremen and get an idea of the geog- 
raphy of the plant. Many workers will find out who she is 
and be more ready to approach her later. She should, at 
this time or during a subsequent tour by herself, locate as 
many as possible of the first aid outfits in the plant. She 
may find all sorts of most surprising materials, salves of all 
sorts seem to be the favorites, and each will be very precious 
to the one who has accumulated them and who probably has 
a little following to whom he ministers. These outfits must 
be cleared up and out and without hurting the feelings of 
anyone. Employes who are naturally interested in such 
things are, through their influence on their fellow workers, 
valuable allies for the nurse if she can get their understand- 
ing and cooperation. They often have quite a name for 
themselves among their associates as being "as good as the 
doctor" but their very interest and intelligence, while dan- 
gerous if undirected, often makes it easy to convince them of 
the advisibility of letting each man stick to his last, doctor 
and nurse as well as cobbler and carpenter. If the nurse 
can teach these men, or better, show them why it is dangerous 
to use shoemaker's wax, paint, tobacco or what not on wounds, 
she will perhaps have taught all the workers in several rooms 
through them. She should remember that these men have 
cared for the injuries of their fellows, not for personal gain, 
but often at a loss of valuable time because they saw a need 
which no one else was meeting. 

Employer, foremen and many workers will soon recognize, 
in the freedom of the injured from infection, justification 
for the presence of the nurse, but she must not forget to 
advertise her work. Publicity and advertising are necessary 
in selling good industrial products and they are no less help- 
ful to the industrial nurse in enabling her to give what she 
has to the greatest number. The rare, and probably pre- 
ventable, spectacular events advertise themselves, but the 
necessity of painstaking care in seeming trifles is hard to 



In the beginning her fellow workers will take an intense 
interest, for a time, in what the nurse is doing. Even in the 
quietest and most humdrum establishments, the imagination 
of many will picture her as spending her time in holding 
bleeding arteries, in bandaging frightful burns and in other 
hand-to-hand encounters with death and disaster. As in 
reality the spectacular seldom does and never should happen, 
it is wise, before this interest cools, to make a special effort 
to show the preventive work that is being done and its results. 
In any busy first aid room a month or less should give ma- 
terial for a report which will show that the new custom of 
having each break in the skin treated has, even though in- 
creasing the number of reported injuries, reduced to almost 
zero the number of infections. If her records are carefully 
kept and tabulated, she should also be able to show that in- 
fections developing in small injuries have followed the in- 
terfering treatment of the fellow worker, or neglect in applying 
promptly for first aid. Barring injuries requiring a surgeon's 
care because they require more than first aid, the writer has 
yet to see one infection develop where prompt first aid was 
given to the untouched wound by an industrial nurse and 
where the dressing was left undisturbed until removed by her. 

A little story of the first month in the first aid room may be 
written so as to interest the workers if its distribution is 
allowed by the management. Even if only given to the fore- 
men to be posted, it will reach many, if each foreman has been 
made to feel that he is an important link between the nurse 
and the workers. The foremen will always be the nurse's 
best allies. Without their help and understanding she will 
find it hard to reach the workers. 

Other means for securing the attention of the workers will 
reveal themselves if the nurse is continually on the watch 
for chances to show the preventive side of her work, both in 
the plant and in the homes. 

Where the company physician spends all, or even a large 
share of his time in the plant, he will probably wish to devise 
his own methods for this sort of publicity and advertising. 



The nurse, however, is in the best of positions to assist him, 
and most physicians in industry would be glad to benefit by 
her observations and by the opportunities derived from her 
close contact with the workers. 

Employers, managers and department heads are easily 
persuaded to make a trial of having the least injury treated 
in the first aid room, and, as soon as they see the quickly 
following results, become enthusiastic champions of the 

It remains to educate the rank and file of the workers. 
This is necessarily a never ending task. Old employes forget 
or think their own injuries of no account, especially those who 
have never happened to have had an infection, and new work- 
ers appear with startling frequency. Effort must never be 
relaxed and the foremen and others in charge of workers 
must never be allowed to grow lax. Notices in pay envelopes 
and posted in conspicuous places throughout the plant, talks 
to the workers in their work rooms at five minutes before 
closing time, noon hour talks in the lunch room, all help. 
New ways of saying the same thing must be invented and 
must be so worded as to be understood by every one. Stories 
of the experiences of a fellow worker will have more effect 
than any number of circulars from a publishing company, 
especially if the worker will tell his own tale at an informal 
meeting. It is, unfortunately, easy to find the stories. 
Too many instances occur in any plant which illustrate 
the dangers of neglect. A rehearsal of the troubles of some 
one who has recently neglected a seemingly slight injury 
has all the human interest of any other gossip and is surely 
a legitimate way of turning a common human failing to 
account. These little stories interest new comers also and 
impress them with the importance of the first aid department. 

Inspirations for the spreading of benign gossip come when 
one is busiest and are apt to be forgotten. A pad and pencil 
in the pocket or a word to the assisting clerk will "nail" 
the idea and preserve it for future use. 

Much educational work can be done in the ways described 



and with individuals, but more far-reaching methods are 
needed. It reflects on some one's forethought when a worker 
appears with an old wound badly infected and says he did 
not know there was a nurse in the plant. For the protection 
of the company as well as for the safety of the worker, there 
should be some sure way of informing each new employe" 
of the provisions made by the company for his comfort and 
safety. Where possible, it is helpful for the nurse to talk 
to the new employes engaged each day. This can be done, 
if allowed by the management, through cooperation with the 
employment department. After the people have once seen 
the nurse and heard her speak, a strange and unreasoning 
but common fear of nurses and first aid disappears. Where 
such interviews are the rule, no one can say he did not know, 
and many infections will be avoided. Such a system with 
a well-enforced rule that each wound, however small, must 
have first aid will do much to prevent workers claiming com- 
pensation for injuries which happened at home or elsewhere 
on Sundays or holidays. It is often impossible to prove where 
an injury occurred unless it is reported at once and, whatever 
the final settlement, one side or the other is sure to feel that 
justice has not been done. 

Frequent visits to the work rooms help to make the nurse a 
familiar figure to the workers. Such visits also give her a 
better acquaintance with the heads of departments and 
foremen and, through them, a familiarity with the different 
processes and their hazards. If the nurse is careful never to 
intrude at a busy season, she will find that all the time she 
can spare for these visits will be well spent. After acquaint- 
ance with the heads of departments and foremen has been 
established, much detail may be arranged over the telephone 
but, in the beginning, every opportunity for getting in actual 
touch with as many people as possible should be seized. It 
may be well to say here that the telephone switch board of 
many establishments is a sort of local newspaper and that 
discussion of the personal affairs of any one has no place over 
such wires. 



The first aid nurse will find her patients to be of four gen- 
eral classes: — Small injuries 1 which no one would think of 
sending to a doctor as they are easily cared for in the first aid 
room, cause no loss of time from work and for the care of 
which most industrial physicians are glad to give the nurse 
standing orders; more serious injuries which are sent to the 
doctor at once but which are frequently sent back by him 
to the nurse with directions for subsequent care; patients 
suffering from some apparently unimportant physical dis- 
comfort, making work unwise for a time, who may be relieved 
by rest, heat or other simple means; acute medical or sur- 
gical cases which develop while the patient is at work but 
with causes having no apparent relation to his employment. 

The greater part of the work of the first aid nurse will 
usually be the care of small injuries, mainly those which 
would, if left to the judgment of the worker, have no care at 
all, or worse than none unless an infection occurred, and would 
then often be neglected until the condition became such as to 
cause inability to work. We have already seen how, in the 
prevention of these needless infections, the nurse has the 
first chance to show the value of her work. Records will 
usually be available so that the nurse's first six months or 
year may be compared with preceding similar periods. If a 
capable industrial nurse is in charge of the first aid work, the 
results are always the same — a marked saving in time lost 
from work and an appreciable reduction in the sum expended 
by the company for the settlement of claims for infected in- 
dustrial injuries. It should not be the special concern of the 
nurse to reduce the medical bills of a company except by 
preventive work. It is even true that they may increase 
after the nurse is installed for she will find many things, other 
than infections, which require the care of a physician. 
Elaborate discussion of first aid methods would be out of 
place in this volume. The industrial nurse's hospital training 

1 Where the industrial physician does actual work in the plant, the 
nurse may possibly be expected by him to attend injuries of a more 
serious nature than she would be justified in handling without his im- 
mediate presence. 


has already taught her to meet emergencies. She knows how 
to treat hemorrhage and shock and how to give artificial 
respiration. She knows the necessity of aseptic and anti- 
septic dressings. She will have the standing orders of the 
company doctor to cover the daily dressings and the care of 
the slight indispositions of the workers. 

It is true that she may be called on to give first aid to 
injuries which are not minor injuries. She may have to do 
something she has only seen others do. She may have to 
meet an emergency in any part of the plant where conditions 
are not, to say the least, what she would find in an operating 
room or in her own first aid room. If she keeps calm and 
takes time to think, the right thing to do will reveal itself to 
her. If she herself remembers and teaches others that in- 
stant action is only necessary in two conditions, she will save 
much unnecessary haste and confusion with resulting danger 
to the injured person. These two conditions are, first, profuse 
venous or arterial hemorrhage and, second, arrested respira- 
tion from drowning, electric shock, or asphyxiation from 
poisonous gases, pressure on the throat or foreign body in the 
larynx. 1 

Shock may need prompt attention, but this is a condition 
familiar to the well-trained nurse and she will see that the 
patient is warmly wrapped and stimulated, if advisable, while 
the ambulance and physician are being summoned. 

The first and last warning to the nurse giving first aid is not 
to do too much. First aid is a temporary means. The nurse 
need not consider the proper treatment of the injury but only 
try to prevent immediate dangers and to keep the patient in 
as good a condition as possible until the surgeon can take 
charge of him. 

If the first aid department of the plant is well organized, 
there will be easily available a supply of sterile gauze suffi- 

1 Paragraphs dealing with the treatment of industrial injuries have 
been made purposely as brief as consistent with a reasonable prepara- 
tion for handling emergencies. They are not intended in the least as 
directions to the nurse nor can they be used to supplant the standing 
orders of the industrial physician. 



cient to cover a large wound, tourniquet, splints, etc. Of 
course no cleaning of an extensive wound is allowed until 
treatment is begun by the surgeon. 

The more serious first aid problems, then, are simple if the 
nurse remembers four points: — 

1. Treat profuse hemorrhage instantly. 

2. Treat arrested breathing instantly. 

3. Treat shock promptly. 

4. Do not wash extensive wounds or remove clots. Cover 
with sterile gauze or clean material while waiting for the 

Working slowly, calmly and quietly, any well-trained 
nurse will do the right thing at the right time. If instan- 
taneous action is not indicated, she may wisely spend a little 
time in reassuring the patient and in quieting his fellow 
workers, of course not delaying to summon surgeon or am- 
bulance as may be required. If surgeon or ambulance are 
delayed, as is sometimes unavoidable, the nurse must plan 
for further necessary care of her patient. If he can be moved 
the nurse can often get him to the hospital, using some 
available conveyance. Much will depend on local conditions 
and on other surgical aid within reach. It is well, in the 
beginning, to have an understanding with employer and 
company surgeon so that, in case the company surgeon can- 
not be reached, the nurse may be free to do her best in getting 
for the injured worker the care needed without red tape or 
unnecessary delay, that whatever action she is obliged to 
take will have the support of the company and of the com- 
pany physician. 

The nurse will not forget to see that the proper persons are 
notified, the company physician, the hospital, the main 
office and the manager. 

The next duty of the nurse, and requiring tactful treat- 
ment, will probably be to notify the relatives of the injured 
one. This must not be left to the excited and garbled re- 
ports of neighbors. If the nurse is unable to visit the home 
of the worker herself, she should, before the closing hour if 


possible, send a trustworthy, sympathetic and tactful person 
with full instructions as to just what to say. No effort should 
be spared to give the friends the exact truth and a careful 
statement of what has been done for the welfare of the 

The third duty, after a serious injury or one whose cause is 
not clear to the nurse, is a visit to the site of the casualty. If 
the employer allows the nurse to follow up these cases, she 
will add greatly to the completeness of her records and to her 
intelligent understanding of her work. 

The industrial nurse working, at times, without the 
immediate presence of the doctor will do too little rather than 
too much in the handling of those cases of disability which 
do not seem to have their origin in the conditions of employ- 
ment. She will, of course, make no diagnosis, will wisely be 
slow in judging the relative seriousness of seeming trifles, and 
will not be too ready to administer even those remedies ap- 
proved by the doctor unless he is present to observe the 
patient. A gargle for the throat may destroy the evidence of 
diphtheria for some hours. A medicine for the relief of head- 
ache may mask important symptoms. Frequent doses of 
cathartics may form the habit of depending on such rem- 
edies. The nurse should do all she can for these people by 
teaching them that regular habits and suitable food will do 
more for them than drugs. If drugs are continually neces- 
sary expert medical advice is indicated. 

In most plants patients, other than those injured in the 
course of their employment, are, when in need of medical or 
surgical care, referred to their private physicians. It would, 
therefore, seem best to limit strictly the giving of medicines 
in the first aid room to those needed in emergencies. 

Indispositions which are not relieved by rest and heat, 
headaches not helped by rest and an ice cap or hot-water 
bag, or any illnesses accompanied by fever have no place in 
the first aid room unless a doctor is in attendance to take all 
the responsibility. The industrial nurse must see that the 
patient is placed where he will have care; at his own home, at 



a hospital, or even at a friend's house, and arrange for medical 
attention. Patients should not be sent home unless the nurse 
is sure that some one will be at hand to give the necessary 
care. When the industrial nurse has little time for visits, 
the local visiting nurse association will often cooperate in the 
care of such patients, and the help of neighbors is not to be 
despised. It is often an advantage for the nurse to accom- 
pany these patients home, but in any case an intelligent per- 
son should go with a sick patient. An automobile for the 
use of the nurse is of great help in getting sick persons out of 
the plant, and it can be used instead of an ambulance for 
many hospital patients. 

Patients sent home should be followed up by the nurse to 
insure proper care and to prevent the spread of possible 

Patients coming to the first aid room repeatedly for seem- 
ing trifles should have careful watching. A study of the 
record of a worker sometimes reveals a surprising number of 
hours spent in the rest room. Examination by the physician 
will often reveal abnormal conditions which may be cor- 
rected or which may be relieved by change of work. The 
industrial nurse should be prepared to give simple eye tests, 
thus being able to prove to the worker his need of the atten- 
tion of an oculist and to prevent his employment where 
normal vision is indispensable. 

Hysteria, if frequent or not explainable by some recent 
strain, should also have careful medical attention. Young 
girls, suffering excessive periodical pain are often the most 
numerous applicants for relief. Nurses can do much for some 
of these girls by cooperation with a local hospital having 
women physicians on the staff. 

Much preventive work is possible in the first aid room. 
Cases presenting the early symptoms of cancer, tuberculosis 
and mental disturbance will be seen by the nurse, not to men- 
tion those showing the often indefinite warnings of other 
approaching illnesses, excessive nervous strain and over- 
work. Recognition of these symptoms by the nurse will lead 



to consultation with a doctor before more serious conditions 
have time to develop. In order to understand many of the 
cases the attending doctor must have a knowledge of home 
environment and outside activities, and the industrial nurse 
should do her part in getting this information before him. 

No matter what the origin of the troubles which bring the 
workers to the first aid room, the removal of the cause is only- 
delayed by the promiscuous administration of drugs. Some- 
thing is wrong, either in the health or habits of the worker, in 
his work itself or in his surroundings or associates. It is the 
nurse's business to discover the cause, whether late hours or a 
poorly planned diet, approaching illness, work which strains 
poor eyes, an unhappy home, a nagging foreman or what not. 
Repeated visits to the first aid room cause much loss of time 
to worker as well as to employer, and both will gain if the 
nurse can help the worker to a better adjustment to his sur- 
roundings. He should be encouraged to solve his own 
problems. Sometimes he may need a good deal of help, but 
the more he is given the moral courage to do for himself, the 
better for him. The workers must not be led to depend too 
greatly on the nurse in any matter. It is easy to make some 
people so dependent on the will of others that they become 
unable to make the simplest decisions for themselves. 

Toothache is a common first aid room complaint. The 
patient wants relief but he seldom wants to go to the dentist. 
As the giving of remedies simply postpones the cure, it seems 
better to have at hand no remedies at all for toothache and to 
insist on each patient going at once to a dentist. If the em- 
ployer provides the services of a dentist, his relation to these 
cases is the same as that of the company physician to the 
medical and surgical cases. Where no such service is at 
hand the nurse must depend on cooperation with the local 
dentists. If it is not possible to make a dental appointment 
or if the patient cannot leave his work, it may be desirable to 
make some application for the relief of pain, but the oftener 
this is done the greater the difficulty in getting all patients 
to have their teeth put in order. 



Workers, and others who should know better, sometimes 
ask impossible services of the nurse and may even accuse her 
of lack of sympathy when she refuses them. Much tact and 
patience are needed in explaining the relation of the doctor 
and the nurse, and it sometimes takes much persistence to 
persuade the patient to consult the doctor when he has ex- 
pected the nurse to cure him. The absolute difference 
between the training, responsibility and duties of physician 
and nurse must be explained again and again to the worker 
and to his friends. No matter how isolated the nurse or how 
far from a doctor, the nurse must keep this distinction in 
mind and must strictly limit her ministrations to the min- 
imum necessary for the well-being of her patient until the 
necessary medical aid can be obtained. 

The control of contagion must, in times of epidemic, be 
considered by the nurse. In a large plant, efficient control 
will depend quite as much on the cooperation and intelli- 
gence of the foremen in the work rooms as on the doctor and 
the nurse. An outbreak of "pink eye" may reach alarming 
proportions in a short time, or an epidemic of influenza may 
spread until the plant must be closed unless each worker is 
closely observed each day and all who show symptoms of 
illness are excluded from the plant and so cared for outside 
that they are not likely to infect others. 

All employes having the direct oversight of others should 
be taught to recognize the symptoms of " colds," which are so 
often the first symptoms of the infectious diseases. They 
should be made to realize the importance of having the 
physician see such cases in order to prevent the exposure of 
others to a possible danger. With the physician in the plant, 
the responsibility for the control of contagion rests with 
him, but where, as in many plants, the physician attends only 
to industrial accidents, the nurse will have a heavy respon- 
sibility. Until the employer is convinced of the advantages 
of more careful medical supervision in the plant by a physi- 
cian, the nurse will often depend for cooperation, in the 
prevention of contagion, on the support of the local health 



department and on the help of the private physicians of her 

In a very small plant the nurse may, in times of epidemic, 
be able to see each worker daily, take his temperature, ob- 
serve his eyes, nose, mouth and throat, and exclude, before 
he enters the work room any employe showing suspicious 
symptoms. In most plants, this plan would be impossible 
t and, if any regular inspection were made, it would have to 
be done by persons instructed by the nurse. Workers show- 
ing symptoms of illness would then be seen by the nurse and 
sent to their family physicians, or other arrangements made 
for their care. 

Aside from the cases of physical disability already de- 
scribed, the industrial nurse will be consulted in all sorts of 
social questions. Unless the nurse can pass these people on 
to a trained welfare worker she must do all she can to help 
them. The very fact that she has helped them in their ill- 
nesses makes them prefer her help to that of others in their 
other troubles. A nurse who is allowed to handle these cases 
gains another point of mutual interest and if she has pre- 
pared herself by a study of social questions, both nurse and 
patient will benefit by this different contact. 

Mothers having children to support may need to be told 
how to secure a mother's pension or require help in getting 
support from a deserting husband. Men and women may 
need to change their boarding places. Workers suffering 
from tuberculosis will need to be informed of the means 
available for their treatment and to be assured that their 
families will not suffer from the idleness of the bread-winner. 
Foreigners will want to learn English. Young people will 
ask about evening study. A parent whose child is employed 
by the company may be anxious as to his future, may think 
there is reason to distrust the influence of some fellow em- 
ploye. Almost any social question may come up. While the 
industrial nurse will not have time to go into the business of 
looking up deserting husbands or holding night schools, she 
should know if there are local agencies filling these needs. 



If no agencies exist she should store all facts in her records and 
be ready, if she has a chance, to present reasons for the 
establishment, in the community, of what is needed. 

The unmarried pregnant woman in industry is sometimes, 
although not so often as is commonly supposed, a problem 
requiring the attention of the industrial nurse. Here she will 
have need of all her sympathy, understanding, resourceful- 
ness, tact and even courage. The girl's associates and family, 
the mother to be and her baby, the guilty man or perhaps 
ignorant boy, the girl's own character, must all be considered. 
This is no place for the usual records and reports, although, 
if conditions of the industry have any bearing on the possi- 
bility of such occurrences, the nurse must recognize her 
responsibility in prevention by making a prompt, frank and 
detailed report to the person or persons most likely to be 
able to change the conditions. Unless she is permitted 
freedom in helping the workers in their personal affairs the 
nurse can be of little lasting comfort to the girl, but she can 
at least make her departure from the plant as inconspicuous 
as possible and she can give the girl the assurance that every 
one will not condemn her wholly. Whether the man should 
marry the girl is an open question. Some girls refuse to see 
him and scorn his support. No one has yet made any rules 
for helping these girls. Those who are not essentially im- 
moral often bear their own burdens and are unknown to the 
agencies which exist for the care of "fallen women." Any 
public health nurse of long experience must know more than 
one unfortunate mother who has supported herself and her 
child and who has forced her neighbors to respect her. Aside 
from the mentally deficient each case presents a different 
set of factors and must be handled differently from any other 
case. The mentally deficient girl should, of course, be 
segregated if there is any way to do it and the nurse has a 
responsibility in seeing that this is accomplished. 

If the girl can be persuaded to tell her mother and if the 
nurse can make sure of the mother's understanding and 
sympathy, the girl's future will often be safest in her hands. 



But many mothers are far from gentle with the daughter. A 
girl may find her own solution. During pregnancy she 
usually thinks she will hate the baby but, if she has the care 
of it, she is pretty sure to love it. The industrial nurse dis- 
covering such a girl cannot do less than encourage her as 
much as possible and help her to go through her pregnancy 
and keep her child. It is seldom comfortable for the girl to 
return to her former place of employment. 

As the efficiency of the first aid room becomes evident, the 
work will become more closely related to the other de- 
partments and the help of the nurse will be asked in other 
than first aid problems. As it is realized that the nurse has 
the confidence of the workers she will be asked to handle all 
sorts of delicate and confidential situations for their benefit. 

For the convenience of the workers in consulting the nurse 
about their personal problems, the first aid room should be 
open during the noon hour. This time should be kept, as far 
as possible, for the workers themselves and should not be 
used for routine work in the care of industrial injuries, which 
can be done during working hours. The nurse must not 
neglect to set aside some other regular time for her own 

While the workers' temptations to make needless visits to 
the nurse are not great, unless the company allows pay for 
time spent away from work rooms, care should be taken that 
justice is done the company and that no one is pampered. 
Idle machines plus idle workers mean a large loss. Where 
time is allowed the workers to see the nurse on their own 
errands, feelings of honor often prevent imposition and the 
privilege is valued and seldom abused. The nurse's office and 
the rest room are not charitable institutions, hospitals, or 
places of amusement. Patients who are really ill should be 
taken, as soon as may be, where they can have care. The 
few who come to the nurse for change of scene should have 
short shrift. 

There is also the question of the nurse's own time. It is 
easy to fritter it away in unavailing conversations. The 



precious and all too short noon hour may be wasted on the 
curious or on the self-centered individuals who love to talk 
about themselves. Fortunately the latter class is small 
among those who work with their hands. In trying to weed 
out the unprofitable conversationalists, the nurse must not 
forget that she can learn much by listening and that even 
gossip, carefully checked up and remembered but not re- 
peated, may be a valuable factor in her usefulness to others. 

Personal instruction in hygiene to individual workers may 
be carried on almost continuously but with any large number 
of employes this kind of teaching does not reach far. Some 
firms are willing to have short talks given during work hours 
in the work rooms. If adapted to the intelligence of the 
workers this is a good means of spreading knowledge. In a 
small town evening classes are sometimes possible, but with- 
out assistance, the time and effort necessary are too great a 
tax on the strength of the nurse. Sometimes the company 
doctor will carry on such a campaign of education. 

Where assistance can be had, the noon hour offers valuable 
opportunities for the education of the workers. A talk by a 
dentist one week, one by the company doctor another week, 
a talk to women, one to girls, a lecture from a baby specialist, 
lessons in the home care of the sick and numberless other 
subjects will interest the workers and give them something 
that will be of practical help to them in their daily lives. In 
some plants instruction is provided by the workers them- 
selves through self-managed clubs. With a leader, such a 
club may be made practically self-supporting and will hold 
the interest of its members better than voluntarily attended 
and unorganized classes. Cooperation with schools, health 
board, Young Men's Christian Association, Young Women's 
Christian Association, will sometimes provide needed in- 
struction outside the plant as well as during working hours. 
Here the temptation will be to use time for the benefit of 
others which is sorely needed by the nurse for her own rest, 
recreation and development. Efficiency is best preserved by 
keeping "fit" mentally as well as physically, and no one can 



do this indefinitely whose life holds no place for the inde- 
pendent pursuit of relaxation, pleasure and inspiration. 

Some firms expect the nurse to teach the workers first aid 
methods. If the employes are expected to use what they 
have learned in the care of their fellow workers, time is usually 
allowed during working hours. Should the responsibility 
of the workers in the care of injuries be beyond the direct 
control and constant supervision of the nurse, wisdom would 
suggest that some other person give all instruction and as- 
sume all responsibility for the work of these lay-persons. A 
nurse is fully justified in refusing to be responsible for more 
than she can closely supervise. Workers trained in first aid 
are sometimes careful and trustworthy, but they are too 
prone to take chances, to underestimate the gravity of an 
injury and to be a continual source of anxiety. 

The industrial nurse will sometimes find that she has a 
number of points of contact with legal matters. In states 
without smoothly working compensation laws, she may be 
called as a witness in the settlement of claims for compensa- 
tion for industrial injuries. Proper behavior in this event 
consists in giving direct replies to direct questions while 
under oath and in making no comments on the case when 
not on the witness stand. If a question is not direct or is not 
understood no answer should be made until the judge has 
said that the question is in proper form. The witness stand 
is no place for conjecture. A prompt and exact statement of 
facts by the nurse in her records may be the means by which 
a just decision is reached. 

In many plants the nurse has a large responsibility in 
carrying out the provisions of industrial laws. Her em- 
ployer may expect her to take charge of accident reports. If 
she has any relation to the employment office she will prob- 
ably be responsible for seeing that other labor laws, espe- 
cially in regard to the employment of women and children, 
are carried out. If she is expected to inspect the plant, her 
employer may depend on her to bring to his attention any 
violation or evasion of laws for the safety and sanitation of 



industrial plants. To meet these responsibilities, and even 
for intelligent daily work, the industrial nurse should make 
herself familiar with the laws of the state in which she is em- 
ployed which affect industry, the laws controlling the em- 
ployment of minors, the work of women, the minimum air- 
space requirements per person, the provision and use of 
seats, the precautions required by law in the dangerous 
trades and any other matters directly affecting workers. 



The importance of a conspicuous and accessible location 
for the first aid room will be appreciated by any one who 
knows the average worker and his frequent lack of observa- 
tion as to his surroundings. Where the plant is. in one build- 
ing or in a compact group of buildings one first aid station 
may be all that is necessary. This is the ideal arrangement. 
In plants where several stations are needed a nurse in each 
would make for safety, but we cannot always have the ideal 
and good work must be done with the facilities at hand. The 
first aid room or rooms should be so located as to be within 
sight of the workers as they go to and from their work and 
should be in as central a situation as possible, equally acces- 
sible from all parts of the plant. The main room at least 
should be where it can be kept open at the noon hour. There 
should be room for present needs, and future developments 
are usually easier where some thought is taken for growth. 
It is unwise to change the location of the first aid room, as 
familiarity of the workers with the place is a large factor in 
their willingness to use it freely. 

A waiting room will be needed and an office for the nurse 
where she may talk privately with those who ask her advice 
or who may have been sent to her for help. Surgical dressings 
and assisting the doctor are but small parts of her work, and 
unless the workers are sure that they will be able to see the 
nurse without the presence of a third person, she will lose 
her most valuable opportunities to aid the workers, the 
doctor and the employer. 

A small surgical dressing room will also be required, and a 
room adjoining, where dressings which might embarrass the 




patient may be done, is convenient. If space is limited, the 
nurse's office might be used for such work. Beds or couches 
are needed and they are often placed in the dressing room, 
a bad arrangement where the work is at all heavy. Patients 
who need to lie down should be quiet, and this is impossible 
if no special rest room is provided. Even though the waiting 
room must be sacrificed, patients waiting in the hall, an 
effort should be made to set aside one room for rest and quiet. 
Two rest rooms, one for men and one for women, are desir- 
able. In order that any seriously injured person may be sent 
away without confusion, a separate screened exit with a 
drive for an ambulance is a convenience. A clothes closet 
and locked cabinets for records should not be forgotten. 
A small cabinet in the dressing room may be used for open 
cases, the cards being transferred to large cabinets in the 
nurse's office. 

It is true that the nurse must often manage with one room 
and may possibly need no more space, but, as four rooms 
and a waiting room are so desirable and suit the needs of 
so many plants, the fitting up of such a place will be con- 

If the plant spreads over much ground, several first aid 
stations may be required. In any case, but one main station 
with four rooms will be used, unless in a very large plant with 
many nurses. The centralization of work, records and sup- 
plies in the main first aid room means economy of time, labor 
and expense. If found absolutely necessary others may be 
opened in remote parts of the plant. These outlying stations 
should be as simple as will suffice for the needs of the part 
of the plant which they are to serve. 

A nurse, working without assistants, must branch out care- 
fully lest she find herself with more than she can properly 
supervise. Often the staff must grow before the work can 
be increased. By slow development, reconstruction and un- 
necessary building may be avoided. 

In one plant there is a large station, such as has been de- 
scribed, and a smaller room at the other end of the grounds. A 



clerk, who has been trained in the simplest first aid methods, 
spends her time in the larger station, keeping all the records 
for both rooms, attending to the supplies and sometimes 
giving first aid when the nurse is in another part of the plant. 
At the other station, a worker near by keeps the key, knows 
how to give very simple first aid and is able to stay with the 
patient until the nurse can be summoned. The nurse can 
always be reached by telephone. She spends her mornings 
and noon hours in the main station and goes to the other 
room when needed. She is provided with an automobile. 

Another plant has a large station, where the greater part of 
the work is done and where records and supplies are kept, 
and twelve smaller rooms in different parts of the plant, 
each in the care of a near by worker who has been trained in 
first aid. The nurse is consulted by telephone when her 
advice is needed. She visits the rooms for inspection at 
regular intervals and in case of serious injury but, whenever 
possible, injured workers are sent to the main station. 

Often small cabinets with first aid materials are placed 
with responsible persons through the plant. It is easy to 
carry this too far, thus defeating the purpose of the first 
aid organization, which is to give each injury, no matter how 
small, the protection of skilled nursing care. Supplementary 
first aid stations are useful in providing a place for an injured 
worker to rest while help is being summoned and in making 
available a supply of sterile dressings with which wounds 
may be covered while the patient goes to the doctor or to the 

In connection with the future growth of the main first 
aid station, the nurse may give thought to some or all of the 
following lines of progress: — Rest rooms for all workers for 
the noon hour, lunch rooms, roof garden, recreation hall, 
circulating library, drying rooms for wet clothes, wash 
rooms, baths, counters for the loan or sale of umbrellas, 
rubbers, stockings, dry skirts, and in the food trades espe- 
cially, a manicure service and freshly laundered uniforms for 
the workers. 



If the industrial doctor spends his entire time in the plant, 
the extension of the work often demands space for X-ray 
rooms, laboratories, offices for various specialists, and for 
dentist and chiropodist in addition to the doctor's own of- 
fices. Where there is such a medical department the planning 
will of course be done by the industrial physician. In any 
case the nurse will do her work more efficiently if she has 
in addition to the equipment at hand, her own private office, 
no matter how small. 

However conspicuous the site for the first aid room may 
be, a number of signs and pointing arrows will be needed 
to make plain where the place is and what it is for. 

In planning the partition of the space allowed, care should 
be exercised that beds and stretchers may be easily moved 
where needed, that doors are wide enough and that narrow 
stairs and sharp turns do not make it difficult to move an 
injured person. If it is possible to have all partitions extend 
to the ceiling, much daily labor of dusting will be saved. 
Careful cleaners for such work are hard to find, and add to 
the expense of the department. A little additional cost in 
providing smooth doors and walls and in avoiding dirt- 
catching corners and ledges will be repaid in subsequent 
saving of labor. The standards of cleanliness in the most 
sanitary factories are seldom those of a hospital, and some 
men are apt to think a nurse unduly particular. Care in plan- 
ning will save much difficulty later on in keeping the first aid 
room in proper condition. 

Plumbing: — The minimum amount of plumbing for a first 
aid room should include an abundant supply of hot and cold 
water, a large stationary sink or basin and a toilet. A slop 
sink should be provided unless there is one near by. In 
addition, a small stationary hand basin in the toilet room 
and a stationary foot tub which may be screened off are almost 
necessities where much work is to be done. A bath tub 
and a shower are greatly appreciated conveniences. A 
pressure sterilizer will save large sums in the purchase of 
sterile dressings and will eventually pay for itself unless con- 



venient, economical arrangements can be made with a hos- 
pital for the sterilization of supplies. Live steam which is 
usually available in manufacturing plants can be utilized 
for the sterilizer. Gas, oil, alcohol or electricity may be sub- 
stituted, but all require careful watching, which is often im- 
possible when one nurse is responsible for the first aid in a 
large plant. 

Walls and Floors: — While tiling is the ideal wall and floor 
material, the expense is often prohibitive. A hard maple 
floor scrubbed daily or a battle-ship linoleum cemented 
down will answer if care is taken that joinings fit tightly and 
that there are no crevices at the edges for the accumulation 
of dirt. The walls may be painted with a hard-finish, wash- 
able paint. An oilcloth covering is manufactured for walls 
which lasts well and is easily washed. It should have careful 
fitting for, unless well applied, it frequently becomes loose 
at edges and corners. As white is trying to eyes, buff or 
French gray color will prove restful. If the light is poor, 
white may be better. 

Even though an unsuitable corner must frequently be used 
for the nurse's headquarters, no effort should be spared to 
make it, as far as possible, an example of cleanliness and neat- 

Decorations: — Decorations seem out of place in a first 
aid room. A few clean, thrifty plants will make the rooms 
as attractive as though elaborately provided with pictures, 
hangings and rugs. 

Furniture: — The number of workers, men and women, 
and the hazards of the industry, as well as the space avail- 
able, will determine the quantity of furniture required. In 
a single room, a writing table, a cupboard, two stools (one 
high and the other of chair height), a dressing table, two 
chairs and a couch may be all for which there is space or 

The furnishing of the group of four rooms, already de- 
scribed, will be considered. The lists following have been 
found satisfactory in industries accompanied by minor 



hazards and employing from five to eight thousand workers, 
with industrial physicians doing most of their work in their 
private offices but coming to the plant in case of serious in- 

For the waiting room, chairs or benches may be chosen. 
Benches fastened to the floor are thought less noisy and may 
be less expensive. 

The nurse's office should have a desk and two chairs and 
the required filing cabinets. A clothes closet should be in 
or near the office. 

The dressing room should be furnished with a writing 
table, a glass covered dressing table, a stool of chair height, a 
high stool, two chairs and a wall cabinet with shelves. 

A two-burner gas plate is less expensive and more practical 
than a regular instrument sterilizer. It should be placed on a 
metal and asbestos-covered shelf of convenient height and 
the wall behind should be protected in like manner. As 
matches may not legally be kept in factories in some states, 
patent friction lighters should be provided. Unless a doctor 
spends his whole time in the plant, such a stove is all that is 
needed for the preparation of sterile water and solutions and 
for the boiling of instruments and utensils. 

One of the stationary wash basins should be placed in this 
room and, if possible, set so that the nurse can stand between 
it and the dressing table, the table being on her right and the 
basin on her left. She will then be able to wash her hands 
when necessary without stepping from her work. When one 
nurse must often bandage fifty or sixty fingers in a short 
time, no saving of time or strength is too small to be con- 
sidered, if she is to have time for any of the other work 
which should be done. 

For the rest room, many firms provide low wicker couches 
with pillow and blanket. These are comfortable when 
workers are allowed to rest in the room but are not suitable 
for the care of injured or sick persons even for a short time. 
Two hospital beds of proper height and provided with 
mattresses, pillows, sheets, pillow covers and blankets add 



greatly to the comfort of both patient and nurse and will be 
used daily in any large plant. Where economy of space need 
not be considered, two rest rooms or even three are sometimes 
provided. One room is furnished with couches for women 
who need only rest, one is provided with beds for the sick or 
injured women workers and another for men. The rest room 
with couches might well be for the use of women wishing to 
rest during the noon hour. Men usually scorn a couch unless 
sick enough to require care. One room is often made to serve 
for both men and women by the use of screens. If one of each 
sex is injured at the same time, it is usually easy to send the 
one less seriously injured to his home or elsewhere. 

If expense need not be too carefully considered, the regula- 
tion, white enameled hospital furniture is usually purchased. 
However, a large sum need not be expended. Many large 
plants maintain carpenter, glazier and paint shops. Often 
articles can be made and painted in the plant. Kitchen 
chairs and tables and cheap office stools, painted white, look 
well and are easily cleaned and refmished. A search through 
the plant will sometimes reveal discarded furnishings which, 
when painted, are more convenient than any that could be 
purchased. A kitchen table painted and provided with a 
glass top answers for a dressing table. A large bathroom 
cabinet will take the place of an expensive one from a surgical 
supply house. A four-leaf clothes horse, painted white and 
provided with heavy muslin covers tied on with tapes, makes 
a neat and useful screen. A small pine stand will make a 
good bedside table. French gray paint is attractive for all 
except the dressing room furniture. 

In planning the furnishings three lists will make plain to 
the management the relative advantages of each class of 
articles. One list should be of regulation hospital furnish- 
ings, the second of cheaper substitutes and the third, of those 
articles which could be made in the plant. The first two 
lists should contain the approximate cost of each article and 
when submitted to the head of the carpenter and paint shops 
he will be able to quote the comparative costs of home-made 



articles. The three lists may then be submitted to the person 
having charge of the purchasing department, or to the man- 
ager, for decision. Sometimes the nurse is asked to do the 
buying and in other plants, a certain sum may be placed at 
her disposal and as long as she does not exceed her budget, 
she is free to use her own judgment. In any case a knowledge 
of cost is valuable and is easily acquired from catalogues. 
No prices are given here as conditions change so rapidly that 
they would be of no permanent value. 

Shades and Curtains: — Few hangings of any sort are needed 
and they should be avoided wherever possible. Straight 
muslin curtains are attractive if frequently laundered, and 
protect the rooms from prying eyes. Shades may be neces- 
sary for this purpose and as a protection from direct sunlight. 
Dark shades are advisable in the rest room and, if an eye 
specialist attends patients in the plant, a way of darkening 
the room in which he works should be provided. A regularly 
attending oculist would, of course, plan his own quarters. 
Shades should be of glazed holland or similar material 
and should be taken out of doors and dusted at regular 

Utensils: — Bowls, basins, trays, etc., may be of white 
enamel, earthenware or glass. If handled carefully, earthen- 
ware or glass last longer than enamel. A good supply of 
small utensils is an economy of time where the work is at all 
active. Fingers may be put to soak while patients are wait- 
ing, and freshly sterilized bowls may be kept ready in suffi- 
cient numbers. 

The following list of utensils has been found ample for a 
very busy first aid room. 
2 teakettles, one for hot and one for cold sterile water. 
1 large fish kettle for sterilizing small utensils and for the 

surgeon's instruments. 
1 small covered basin with a handle and wide enough to 

hold the nurse's instruments. 
1 pitcher (2 qt.) for mixing solutions, etc. 
1 pitcher (1 pt.). 



2 hand basins. 
6 bowls (1 pt.). 

3 bowls (4 qt.). 

1 covered jar for dressings. 

1 covered jar for sponging cotton. 

1 irrigating can and tube. 

1 mug (3^2 Pt-) for keeping the points of fresh instruments 
sterile in solution. 

1 mug {}/2 pt.) of another color or shape for used instru- 

1 measuring glass (500 cc). 
6 small medicine glasses. 

6 tumblers. 
6 spoons. 

2 clinical thermometers. 

1 thermometer for testing solutions. 

3 cups, plates and spoons. A sick or injured person is often 

benefited by a small lunch. Food is not a common 
first aid room need but it should be possible to give a 
little nourishment, when that is what the patient 
needs. 1 

2 trays for carrying dressings to the rest room. 
Instruments: — Few instruments are needed by a nurse. If 

cases requiring surgical care are treated in the doctor's 
private office or sent to a hospital, the only instruments re- 
quired are for handling gauze, removing splinters and for 
carrying out the doctor's orders in the cases which he sends 
for redressings, possibly a probe and a grooved director for 
inserting drains under the orders of the surgeon. If the 
doctor does actual surgical work in the first aid room, he will 
order his own instruments and the nurse should keep them 
apart and allow them to be used by no one else. A good 

1 Where there is no lunch room in the plant, a little coffee, malted 
milk a can of evaporated milk and a few crackers, purchased by the 
nurse will make it possible for her to make an occasional patient feel 
that he has been looked after in every way. A worker who has eaten 
no lunch should not be sent home after even a slight injury if he is 
faint and hungry. 



supply of forceps and scissors should be at hand in a large 
plant. In some small plants a nurse might easily manage with 
one instrument of each kind. 

With frequent sterilizations, the following list will answer 
for a first aid room caring for from fifty to a hundred dress- 
ings a day: 

1 large spatula. 

1 small spatula. 

6 small, straight, pointed scissors. 
6 small dressing forceps. 

2 splinter forceps. 

3 probes 1 for redressings sent to the nurse by 
3 grooved directors J the doctor. 

Drugs: — As the industrial nurse, working often without 
the immediate presence of the doctor, even though under his 
directions, may be subject to misunderstanding, she should 
protect herself from unjust criticism by limiting her supplies 
so that it is quite clear she cannot possibly take upon herself 
the physician's duties. 

Aside from supplies specially ordered by the doctor, the 
following list of drugs 1 has been found ample in several large 

Boric acid. 

Essence of peppermint. 

Jamaica ginger. 

Aromatic spirits of ammonia. 

Oil of cloves. (Of doubtful utility.) 

White wine vinegar. 

Bicarbonate of soda. 

Castor oil. 

Tincture of iodine 7%. (To be diluted to 3% or less be- 
fore using. 

Bichloride of mercury tablets. (Not an absolute neces- 

1 Alcoholic stimulants have no place in the first aid room unless by 
the express wish of company physician. Coffee should be available. 



Colodion. (For use in sticking down rough edges of finger 
dressings, not for sealing dressings or application to 

Benzene or gasoline. (For removing plaster from the skin.) 

Carbolized vaseline. (For chapped or rough hands which 
interfere with work.) 

Boric acid ointment or other burn ointment in large quan- 

Soda bicarbonate ointment (3%). 

Some cathartic pills or fluids are usually provided with 
the advice of the doctor, but their use should not be en- 

A hypodermic case and certain stimulants are left with the 
nurse by some doctors, but they may usually be dispensed 
with. Unless the plant is at some distance from a doctor 
external heat will answer in most cases until assistance can be 

Antidotes to any poisons used in the industry should be at 
hand. An emetic or a tank of oxygen may sometimes be 
needed. The doctor should assume the responsibility for 
saying what drugs should be at hand, except home remedies 
and simple antiseptics and disinfectants which might be 
found in the medicine closet of any careful housewife. 

After consultation with the company doctor, provision 
must often be made for the treatment of pediculosis, ring 
worm, scabies, etc. Children who have to work seldom have 
homes where such treatment is properly carried out. They 
are usually sensitive about their condition and a nurse will 
gain their confidence best by quietly helping them. When 
they know what proper treatment is, they often apply what 
they have learned in the treatment of the whole family. 

Dressings:— It is practically impossible to purchase sterile 
dressings which may be used in industrial first aid rooms with- 
out waste. Gauze should be purchased. Bandages are 
cheaper when bought than when made in the plant. Sterile 
bandages are unnecessary, and the plain cut gauze bandages 
are much cheaper and serve as well as those which are torn 


or cut to thread and elaborately wrapped and sterilized. 
Instead of absorbent cotton, by-products may sometimes be 
utilized in the textile industries. In cotton mills, waste may 
be boiled in soda and well rinsed at the bleach house, then 
sterilized in the first aid room for use in cleaning wounds and 
wherever absorbent cotton would be used. If run through a 
carding machine, it will be easy to handle, very absorbent 
and will look nearly as well as the cotton manufactured for 
surgical use. If a hundred pounds are prepared at once, the 
labor is very little and the supply will probably last several 
years. Heavy muslin makes good dressing covers. 

A box shop is a convenience found in many plants. Gauze 
may be cut there. This means a great saving of time and the 
product is perfectly suited to first aid and to many other 
dressings. Two sizes are useful, two inch squares and four 
inch squares. The smaller size is just right for ringer dress- 
ings and many other uses and the larger size, with a few 
yard length rolls, some half yard squares and cotton will be all 
the dressings that can possibly be needed. 

Other Medical and Surgical Supplies: — In addition to those 
already mentioned, a well-equipped first aid room will be 
supplied with the following articles: 

Splints of light strong board for leg, arm and thigh. 

Bass wood splints, wooden tongue depressors, applicators 
and tooth picks. 

Paper bags or newspaper for wrapping soiled dressings. 

A sanitary trash can. 

Eye cups. 

Medicine droppers with red bulbs. 

Medicine droppers with white bulbs. 

Tourniquet. (In plain sight, always in the same spot and 

frequently tested.) 

6 fruit jars with clamped covers for drains, swabs, etc. 

Qi pt.) 

Slings. (May be made of cheap unbleached cheese cloth.) 



Adhesive plaster. (When rolled on metal spools the cost is 
much greater than when protected with muslin and the 
latter is nearly as convenient.) 

Ice bag. 

Hot water bag. 

Stomach and rectal tubes. 

Stretcher. (One that can be used as a cot.) 

Hand brushes. 

Pins (straight and safety) . Tied bandages are an economy. 
Platform scales. 

Linen: — An amount of linen must be provided according 
to the size of the plant. In one plant with from five to eight 
thousand employes, where the laundry was done weekly, the 
following was an ample supply: 

3 dozen sheets. (Sheets are used instead of bed spreads.) 

2 dozen pillow cases. 

12 dozen hemmed huck squares, about 9 inches square, for 
hand towels 

2 dozen dressing towels, to be sterilized. 

2 washable laundry bags. 

1 blanket for each bed or cot. 

Rubber sheets and pillow covers. 
Laundry bags of ticking 1 yd. by V/ 2 yd. when finished, pro- 
vided with a slit halfway down the middle of the front, 
four large metal eyelets in the upper edge matching four 
hooks on toilet or bathroom wall near a window, are neat and 
practical. As laundry work will probably be sent out only 
once a week, great care must be taken as to the condition 
of articles placed in the bag. Hotels and department stores 
and food industries usually maintain laundries, and textile 
mills have bleaching rooms where soiled dressings and towels 
may sometimes be washed. Dressings to be burned should 
be sent to the furnace in a firm bundle. 

Sometimes necessary sewing may be done in a sewing 
room connected with the plant. Thread mills have testing 
rooms where each lot of thread is tried on sewing machines 
and where, incidentally, sewing is wanted. Hotels, depart- 



ment stores and clothing industries have people to do 
sewing. A nurse's thoughtfulness in finding out how she 
can use what is at hand in the way of such help will usually 
be appreciated. 

In fitting up the smaller first aid stations, the equipment 
should be simple and fitted only to the needs of the par- 
ticular part of the plant to be served. A careful study of the 
hazards will show that suitable forceps are needed when 
workers may have splinters or needles break off in their 
fingers; where poisons are used in the plant there should be 
antidotes at hand, and some one on the spot should know 
what to do in case of injury. (Chemists are employed 
in many industries and they sometimes have this matter 
in hand.) Other needs should be considered, such as poison- 
ous gases, electric currents, caustic alkali and acid which 
may cause burns, particularly eye burns. The industrial 
doctor must be consulted until all these danger points have 
been covered. 

It is impossible to describe all the hazards in industry. 
Employers and state and federal departments and safety 
organizations are working for the decrease of danger. But 
it can never be entirely abolished. When the machinery 
is as safe as it can be made employes still cause injury 
to themselves and to others by carelessness or blun- 

In keeping the smaller first aid rooms supplied with the 
necessary articles, a system of regular inspection is essential, 
or supplies will disappear or be tucked away and not be found 
when wanted. Some one person must be held responsible 
for the condition of each station. A list of articles with the 
places in which they are to be kept will aid both inspector 
and the person responsible. The following list has been used 
in supplementary first aid rooms where the needs were of a 
general nature: 

Top Shelf:— Splints. 
Paper bags or newspapers (for wrapping soiled dress- 



In original muslin 

1st Shelf from Top: — 
Jar of cotton. 

3 packages of sterile gauze (2 in.) 
3 " " " " (4 in.) 
3 rolls " " " (lyd.)f 
1 package " " swabs (small) J 
1 eye cup. 

1 eye dropper with white bulb, boiled and in boric solu- 

Boric acid solution. 

Tourniquet, extreme right in plain sight. 
2nd Shelf from Top: — 
Cup and saucer, spoon. 
Sugar. (May be omitted.) 

Essence of peppermint. 
Jamaica ginger. 

Aromatic spirits of ammonia. (Rubber cork.) 
Oil of cloves. (May be omitted.) 
White wine vinegar. 

Castor oil. (Sterilize after using and seal for next time.) 
Small measuring glass. 
3rd Shelf from Top:— 

Tooth picks in covered jar. 

2 slings. 

Adhesive plaster. 
Spatula (small) 

Dressing forceps 
Splinter forceps 
Large needle 

[ 6 one-inch. 
Bandages \ 6 three-inch. 

[ 3 four-inch. 
Bottom shelf: — 

Tincture of iodine, 2% to 3%. (Tight rubber cork.) 
Medicine dropper with red rubber bulb. 

Sterile and in original wrapper. 




Carbolized vaseline. (For rough hands, not for wounds.) 

Boric acid ointment or other burn ointment. 
Other articles: — 

Ice bag on proper hook. 

Hot-water bag on proper hook. 

Cotton for padding splints, etc. 

2 sheets. 

2 pillow covers 



2 hand brushes. 

1 hand basin. 

2 bowls (small) 
1 mug. 

Books for Reference, etc.: — For convenience a few reference 
books should find a place in the nurse's office. A directory 
of the plant containing a list of department heads, foremen, 
and other persons in authority with their telephone numbers, 
and in a large plant, a map of the premises will be required. 
A telephone directory and a street directory with a map 
of the town and a purchased or home-made directory of 
local social agencies, are essential. 

A small professional library will be frequently consulted. 
Such books are often owned by the nurse and she will of 
course wish to possess what she needs for her own personal 
information and development. A work on industrial diseases, 
one or more books on first aid, especially with reference to 
methods of teaching the subject to laymen, bulletins of local, 
state and federal health and labor departments, especially 
those which treat of the health and accident hazards of the 
particular industry, a small manual of materia medica, a 
medical dictionary, will all be found useful and the list will 
be increased by any industrial nurse who gets a vision of 
her opportunities and prepares herself to grasp them, 



A few elementary books on personal hygiene, practical 
dietetics, child care, first aid in the home and kindred sub- 
jects, if provided by the company, may be profitably used 
as a loan library. Workers may be interested, while a dressing 
is being done or other service rendered, and will often be glad 
to read a practical book on the subject of their needs. 

The nurse's office also seems the logical place for the nurse's 
own professional periodicals. The Survey, The Public 
Health Nurse, and trade journals dealing with questions of 
sanitation and safety. 

There will be little time for real reading but points may be 
looked up when necessary, the journals may be taken on 
necessary car trips and the total value will amount to an 
appreciable sum. 

Economy in the Use of Supplies and in other Expenditures: 
For her own self-respect and for the example she unconsciously 
sets for those who watch her work, if for no other reasons, 
the industrial nurse will employ every means possible in the 
economical use of supplies and in keeping the expenses of 
her department at the lowest point consistent with efficiency. 
Most firms, even though liberal in providing not only what 
is needed but all that is desirable, keep careful account of the 
actual cost of each department and the amount of overhead 
charge of each, compare these costs from year to year, con- 
sider the work done, and the results accomplished. The total 
cost of the work is also divided by the number of employes, 
thus showing the average cost per worker. Such figures are 
often exchanged by employers who take great interest in 
comparing costs and results. Of course many of the nurse's 
best results are intangible, but many of them are reduced to 
black and white in statistical departments. The systems 
of statistics differ in different plants so that estimates of 
the cost of very similar service have been seen varying from 
$.50 to $2.50 and even $5.00 per year per employe. Of course 
in small plants the cost is relatively more than in larger ones. 
One of the reasons that many small employers give for not 
establishing industrial nursing is that they cannot afford it. 



It would seem that industrial nurses should be able to show, 
from their uniform results and by their uniform methods, 
that no employer can afford to do without industrial nurs- 

Labor organizations and industrial relief associations are 
appreciating the value of industrial nursing both in the homes 
and in the plants and should show an increasing interest 
where it is known that industrial nurses are conservative 
in expenditures, as well as efficient in the prevention and relief 
of injury and illness. 

Personnel: — Except in small plants or in those in which the 
duties required of the nurse are of a very limited nature, she 
will require some assistance from the very first. An intelligent 
young girl, who can be trained to do clerical work and taught 
the simplest first aid, will be able to keep the records, see to 
the general order of the station, assist with dressings and 
attend to the preparation and sterilization of supplies. She 
should be a person of some refinement and dignity as she 
will sometimes be alone and must be able to meet the workers 
in a pleasant way, but without encouraging unpleasant fa- 

With the help of one clerk, the nurse should organize an 
efficient first aid service and establish a system of records, 
possibly doing a little home visiting, but surely learning the 
needs of the plant so as to be ready to meet them if she is 
given the opportunity. 

A nurse's time is too valuable to be used in keeping simple 
records and in much of the other work which might as well 
be done by an untrained person. Where the workers are en- 
tirely men, these duties are sometimes assigned to a young 
man, but in most plants a woman or girl of the right type will 
be more satisfactory, will show more interest and will be less 
given to "skylarking." 

A good deal of development and extension of work will be 
possible, without additional help, as the industrial nurse 
becomes accustomed to her duties and surroundings. 

The further increase of the nurse's staff will depend en- 



tirely on the wishes of the employer, the other welfare ac- 
tivities in the plant and on the ability and vision of the nurse 
herself. She may have, eventually, other nurses, additional 
clerks, a matron for the rest rooms, a lunch room force and 
others on her staff, but she may be sure that such growth 
will seldom be possible unless the financial advantage of 
each step is clearly appreciated. 



The visiting nurse in industry is a logical development 
following the needs discovered by the industrial nurse in the 
first aid room. 

An employe suffers an industrial injury and may not re- 
turn to the doctor for redressing or to his work when he has 
recovered. The first aid nurse will be asked to look him up. 
She may see that he goes to the doctor. She may find that 
he is not able to do so and that she must ask the doctor to 
visit him. If he has recovered, she may find that he has gone 
to work elsewhere. 

A patient is sent to the hospital from the plant. Report 
may come that he insists on going home, even though this 
will be dangerous. A visit from the nurse may show that 
she can easily relieve his mind about conditions at home or, 
if he is not satisfied in the hospital, she may be able to ex- 
plain conditions to him, or even have them adjusted so that 
he becomes comfortable and contented. 

A sick worker may be sent home from the plant and the 
nurse, not being sure of home surroundings, may consider 
it her duty to make a visit, even going on a holiday if she 
can find no other time. 

The employer may ask to have pensioners visited. The 
mutual benefit association, though not employing the nurse, 
may request visits to those claiming benefit. 

The employment department or heads of other depart- 
ments may ask to have absent workers looked up. The 
nurse on her visit may find a sick person needing care and not 
knowing how to get it. She may discover a worker obliged 
to stay at home with a sick wife. She may find one, as the 



writer did, who has lost his pay envelope and has no money 
for car fare. 

The home visiting specially requested will increase as it 
is found that the nurse is able to be of real assistance. 

Unless in a very small plant, the need of an assistant nurse 
will soon be evident. In many communities an automobile 
will enable one nurse to make fifty to seventy-five per cent 
more calls. As the nurse finds her way more and more into 
the homes, innumerable questions appear, in the solution of 
which she can be of more general help than a home visitor 
of any other training whatever. 

Without intruding her presence, without much added 
expenditure of time and almost without realizing it she will 
be compelled, in addition to the definitely requested work, 
to enter more or less into the field of general public health 
nursing. Home conditions so closely affect the efficiency of 
the worker, and the work of the nurse is so valuable in chang- 
ing these conditions for the better, that a hard and fast line 
between industrial and other visiting nursing is impossible. 

Employers see that they must do something towards 
making our masses of foreign laborers into good American 
citizens. This can best be done through the homes and the 
schools and no one can enter the homes so naturally, serve 
them so well, or make herself so welcome as the industrial 
visiting nurse. 

With a knowledge of the background, habits and super- 
stitions of the workers in their homelands and a clear insight 
into the essentials of wholesome American family life, the 
visiting nurse is, according to the statements of many em- 
ployers and others in a position to know, the most efficient 
single agent in the making of American citizens and in the 
promotion of mutual understanding in industrial relations. 
The industrial visiting nurse serves the employe while serving 
the employer in ways too many to enumerate. 

Reaching the home, as she often does, before serious illness 
has appeared, and while the family life is at its normal state, 
she has a better opportunity than any other social worker 



for assisting in maintaining or developing a home life where 
provision is made for the needs of normal existence; for 
health, education, employment, recreation and moral and 
spiritual inspiration. 

By her friendship with people of many races, she learns the 
good in the life and habits of each and can assist in preserv- 
ing, from other civilizations, much that should make our own 
richer. One of the surest ways of keeping a family of foreign 
birth united, happy and prosperous in the freedom of our 
republic is to impress the young people with the wisdom and 
good sense of their parents. The schools sometimes make an 
effort to do this, but their opportunities are not those of the 
nurse who understands the parents and is often able to per- 
suade them to adopt the good in our life without entirely 
changing customs to which they cling. 

Industrial efficiency depends so closely on a healthy happy 
home life that employers often send visiting nurses into the 
homes in order that regular instructive visiting nursing may 
be done as well as following up into the homes affairs which 
have had their origin in the plant. 

There seem to be two general plans for the organization 
of visiting nursing service by industry. One is often employed 
in a small or backward community and the other in a large 
progressive town already supporting many social agencies. 

In the former case, the employer may, through the serv- 
ices made available to his force, seek to foster and develop 
a sense of civic responsibility on the part of the community. 
Through the industrial visiting nurse's care of the employes, 
a demand for a like service for the entire population may be 
developed. In connection with the industry, dispensaries, 
hospitals, schools, baby conferences, prenatal care, visiting 
housekeepers, recreation centers and other social agencies in 
addition to a visiting nurse service may be available to the 
employes. They will all add to the well-being of the people. 
When the community realizes the need of any one of these 
agencies, the employer may well abandon the service and 
assist the community in establishing it, strengthening its 


activities through his own cooperation, and that of his health 
department and his visiting nurses. In this way the em- 
ployer becomes a strong force for the improvement of the 
general health and happiness of the community. 

In large progressive towns, already provided with a visiting 
nurse association, baby welfare agency, and other efficient 
means for public health education, the employer often wisely 
limits industrial nursing activities outside the plant to a 
nursing service which will seek out the family of each sick 
worker and then cooperate with existing agencies for the 
care of the sick and the education of the family in habits of 

After the first visit is made and the right contact estab- 
lished between the patient and the firm, a great saving of 
time and duplication of effort will often be made by arranging 
with the local visiting nurse association for the subsequent 
bedside care. The family is saved the unnecessary visits of 
numerous health workers and from what sometimes seems to 
the patient conflicting advice. 

There is much discussion as to whether public health 
nursing should be general, each visiting nurse attending to all 
nursing in a neighborhood, or specialized, one nurse looking 
after the babies, another attending to the maternity cases, a 
third visiting the tuberculous patients. One method pre- 
vails in one locality, the other method in another locality. 
Whatever the wisdom of each course, the industrial nurse 
must always generalize. In so far as there are practical ways 
of cooperating with other nurses, specialization may be 
possible, but the most efficient industrial nurse is one who is 
the " family nurse " of each worker in much the same way as a 
physician becomes a family doctor. 

Where the industrial visiting nurse depends on the local 
visiting nurse association for bedside care of her patients, she 
should not feel that this relieves her of all responsibility for 
actual nursing work. When she finds something to be done, 
she will lose greatly in the estimation of those she visits if 
she allows the need to wait for the visit of another nurse. 



She should always be ready to give actual bedside care. She 
may seldom require a visiting nurse bag but she should 
carry one, and keep it as well supplied and in as good order 
as would be expected of a nurse giving only bedside care. 
(This same bag or another like it is often useful for carrying 
about the plant for use in cases of emergency when the 
patient cannot be carried to the first aid room.) 

Cooperation with the local visiting nurse association means 
the loss of some of the value of personal service to the worker 
and the resulting close personal contact. On the other hand, 
it aids in the support of a needed community agency and 
makes possible the nursing care of many workers without a 
great increase in the size of the industrial nursing staff. Such 
cooperation has been found useful in several cities. In some 
cities a charge of fifty cents a visit has been made and in 
others the firm pays into the funds of the visiting nurse 
association a fixed annual sum (ten cents in one place) for 
each employe on the pay roll. 

An easy way of starting such a service for employes is to 
have the work entirely undertaken by the local visiting nurse 
association. The visits can be made by the nurses in their 
districts or by the association appointing one nurse to do the 
work of one plant, the nurse being responsible both to the 
firm and to the association. This plan has the advantage of 
assuring the continuation of nursing service in spite of changes 
of personnel, and offers supervision to inexperienced workers. 
Unless the nurse doing such work spends some regular time 
in the plant and becomes identified with it, there may be very 
little adaptation of the work to the needs of the industry and 
less of the close personal relationship which should exist 
between the nurse and patient, not because the nurse is a 
nurse but because, in addition, she is the personal representa- 
tive of the company, or of the organization of workers who 
employ her, and is known to have been chosen by them and to 
be responsible to them. 

In any of these plans great elasticity will be needed to 
avoid duplication of work and to maintain the closest possible 


relation between the industrial nurse and those she visits. 
Aside from pointing out the relative advantages and dis- 
advantages of each method, as they appear to the writer, no 
general solution can be offered. The needs of the industry, 
the local agencies at hand, the prejudices of the workers and 
* many other factors will guide the employer in his decision 
as to what means he shall take to establish a visiting nurse 
service. Good and valuable work is possible for the nurse no 
matter what the details of organization may be. 

One prejudice of workers should be considered. In many 
towns the visiting nurse association has the name of being a 
charity. Where it is not plain that the association serves all 
classes and collects pay for service, consideration for the 
workers often influences the employer in establishing his own 
service with its resulting benefits to the firm and greater 
acceptability to the workers. 

The visiting nurse in industry meets the same problems 
and must handle them in the same manner as any other 
visiting nurse. The backing of the company is perhaps not so 
strong or general as that of a good visiting nurse association 
because all the elements of the population are not repre- 
sented. 1 2 

The local physicians sometimes feel that a nurse has been 
thrust upon them unasked but they are usually glad to accept 
her services for their patients when they find her obedient to 
their orders, quick in reporting a change in a patient's condi- 
tion and thorough in her care of the sick. 

Her technique should be that of the best visiting nurse 
associations 3 and because she is so often without supervision, 
she should be careful to make it plain that she can keep up 
the standard of her work without example or precept. 

1 In this connection, help and inspiration are to be found in Miss 
Gardner's " Public Health Nursing," Part II, Chapter V, The Nurse 
Working Alone. 

2 Where the nurse is paid by an association of employes or of em- 
ployers with employes, the nurse's backing, at least with her patients, 
is all that can be desired. 

* " Visiting Nurse Manual," Edna L. Foley, R. N., page 43 to page 71. 



In a small industrial town, a nurse who expects to do bed- 
side nursing in the homes of the workers will gain by taking 
the time at first to call on each physician in the community. 
In either a small town or in a large city, if there is a visiting 
nurse association having standing orders approved by all the 
doctors, the industrial visiting nurse will do well to follow 
these orders in her work in the homes. If she is the only 
visiting nurse and especially if she is a newcomer, it may be 
well to obtain if possible such orders through the local 
medical society. The advisability of this step will depend on 
local conditions. Sometimes one or more local physicians 
may take this matter up for the nurse, or her employer 
may be willing to do so. After the nurse becomes known 
she may be able to do it for herself. Until some standing 
orders are provided for her use she will necessarily use great 
caution in doing anything for her patients except to make 
them comfortable until she has consulted the physician in 

The wise general rule for visiting nurses will be observed: 
"It is a wise rule that a doctor shall be in attendance on 
every case cared for by public health nurses and it is an 
equally wise rule that the nurse should continue on the case 
only if it is his pleasure. It will usually be his pleasure if she 
does her work well, or if he finds that patients, as often hap- 
pens, refuse to call him unless he permits such service. In 
case of change of doctor, and every public health nurse is 
familiar with the dizzy rapidity with which such changes 
take place, it is her duty to put herself in immediate com- 
munication with the new doctor, and usually it is wise to 
have a word on the subject with the departing one, lest she 
become involved in the complexities of the situation." 1 

The work of the industrial visiting nurse differs from that 
of the ordinary visiting nurse in that most patients visited 
are seen in their homes by the nurse before the doctor has 
been consulted. Often the worker is not sick but at home for 
other reasons. In many cases, though not well, he does not 
1 " Public Health Nursing," Miss Mary S. Gardner, page 45. 


consider his illness of enough importance to warrant the 
expense of a doctor's visit. The nurse's duty is to persuade 
the patient of the wisdom of seeing a doctor if necessary and 
then, if illness continues, to see that he understands and 
carries out his physician's orders and that he has whatever 
nursing care is required, teaching the patient and his family 
as would any other visiting nurse. 

Every employe must be acquainted with the medical, 
surgical and nursing services at his command. While nothing 
should be forced upon any one, the worker may surely be 
taught by a sympathetic friend (the nurse, or if he does not 
know her well, his neighbor who has known her longer) to 
want what is to be of benefit to him. 

When visiting nursing is established in an industry, a 
systematic method by which calls come to the nurse is neces- 
sary. Calls will undoubtedly come from many sources; from 
the employment office, the heads of departments, the workers, 
the company physician, and from the families of the work- 
ers, as well as from outside sources such as the visiting nurse 
association, industrial benefit associations, churches, etc. 
However, in order to be really efficient, each absentee should 
be visited at least once unless it is definitely known that he is 
not sick or that he needs no help. A regular daily system of 
notification from the employment office or from the time- 
keepers is the only way by which those needing aid can be 
promptly reached. In a small town the nurse may "happen 
to hear" of those needing her help but, even in the smallest 
place, this is an uncertain way of getting work done and 
in a city, where the need is often greatest, it is of no value 
at all. 

Without prompt visits to all absentees, a great amount of 
preventable misery is sure to occur, such as the case in New 
York City where a cook, employed in a restaurant, was away 
from work on Friday. Her absence was reported to the nurse 
on Monday morning and in the afternoon a visit was made. 
The patient was alone and no one had entered her furnished 
room since the preceding week. She was delirious, her 



temperature was 104, two gas lights and an oil heater were 
burning and the month was August. No time was lost in 
sending the irresponsible patient to the hospital in an am- 
bulance, where it was found that she was suffering from 
typhoid fever. Her friends had gone to the country for a 
vacation and did not appear for several days. This is, of 
course, an extreme case, but it is not at all unusual to find a 
person ill and in need of care but without the least idea of 
how to go about getting help. 

The industrial nurse who visits in the homes will not act as 
a detective, and the private affairs of her patients will be 
treated with the same consideration and confidence as 
similar information coming to the attention of the private 
duty or hospital nurse. When her patients have learned 
confidence in her discretion her opportunities for giving real 
help will be greatly increased. Many personal matters are 
sure to come to the industrial nurse's attention which concern 
no one but the patient or possibly his family. It is sometimes 
necessary to get the sympathy and understanding of the em- 
ployer or of someone else high in authority and in close touch 
with the plant. The privilege of consulting at will with the 
employer or general manager is often allowed an industrial 
nurse and should be greatly valued by her. If she remem- 
bers the many demands upon his time and his great responsi- 
bilities, is sure of the accuracy and importance of her facts 
and presents them briefly, many an employer is only too glad 
to give freely of his time and interest. An industrial r nurse 
should beware of the failing of continually asking favors for 
employes. Favors do not bring any desirable results to 

The visiting nurse in industry will work with the various 
family physicians of her patients rather than, as in the first 
aid room, solely with the company physician. Coming, as 
she often does, without the knowledge of the family doctor or 
even before he has been called to attend the patient, she 
must make it very plain to both doctor and patient that she is 
carrying out the best principles of nursing ethics and the 


best visiting nurse technique. She should be exact and par- 
ticular in keeping all bedside notes and records, both in the 
patient's home and in the nurse's office at the plant. Her 
responsibility is fourfold: to her patient, to his physician, to 
her employer and to herself. Only by the same careful 
record of orders, treatments and observations as is required 
in a hospital can a nurse protect herself from chance of 
criticism. Her continued usefulness in her chosen work may 
sometime depend upon promptly recorded facts. The visit- 
ing nurse must spend enough time in the plant to keep her 
records or to see that they are kept, to get her calls and to see 
workers in the plant who may wish to consult her. The noon 
hour will often be a good time to see the workers. 

The visiting industrial nurse does not finish her duties when 
her patient no longer needs nursing care. She will be ex- 
pected to keep in touch with him until he is able to go to 
work. This attention during convalescence is an important 
factor in keeping the worker patient until he is fully recov- 
ered and in adjusting him to his work later. Arrangements 
for medical examination by the company doctor should be 
made when necessary to prevent the worker returning too 
soon or while in a condition to be a menace to others. Many 
firms make such an examination a routine requirement, and 
where this is not the case, the industrial nurse should assure 
herself, as far as she can, through consultation with the 
family physician, that the patient is able to return and that 
he has suitable work. This precaution is of special impor- 
tance where the illness has been long or obscure, where indus- 
trial disease has not been excluded, and in all respiratory 

After return to work many patients should be kept under 
friendly observation by the first aid room nurse. Some will 
need to be reminded to return to their doctors; perhaps the 
foreman will have to be asked for a time allowance for the 
visit. Some may be ordered treatment by their doctors which 
will have to be given by the nurse in the first aid room. 
Others may not seem strong and the nurse may make some 



excuse to get them to her office from time to time in the noon 
hour. Young persons and others will have weight cards kept 
so that the nurse will be able to give the doctor valuable in- 
formation in sending a patient to him. The first aid nursing 
and the visiting nursing are inseparable if good team work is 
to be done. 



The First Aid Room: — The first aid room nurse or her clerk 
will, in most plants, be expected to open the first aid room 
when work begins in the morning. Where, as in urgent war 
work, the plant runs continuously, the first aid room will 
probably never be closed. Some firms, under these condi- 
tions, employ a male attendant for the night work. There is, 
however, no more reason to exclude a nurse from night work 
in an industrial first aid room than to expect hospital order- 
lies to do all the night work in a hospital. Nevertheless such 
use of a woman's time might be considered a violation of the 
labor laws of some states. With three shifts of nurses, a 
comfortable time schedule would be possible and the night 
workers, who are surely not less liable to injury and illness 
than the day force, would have the same protection. Em- 
ployers, who have had experience with both nurses and male 
attendants, are unanimous in saying that the former are more 
efficient, more interested and to be preferred even in estab- 
lishments where the employes are all or chiefly men. 

Any objection a nurse might have to such employment, 
aside from the disadvantages inseparable from any night duty, 
vanish when she learns how much respect even the roughest 
man has for a trained nurse. The writer has yet to hear of 
even one instance of intentional rudeness or disrespect from 
any male employe to any industrial nurse at any time. It 
would, nevertheless, be wise in choosing trained nurses for night 
work to select women of exceptional dignity and mature years. 
A well placed first aid room will not be in an isolated location 
and, if used at night, care should be taken to have it where 
all that goes on within may be easily observed from without. 

In a plant requiring continuous first aid service, the indus- 
trial nurse will probably be fully occupied with first aid work 
and redressings, together with the care of workers who are 




taken sick in the plant. In order to have any time at all for 
other work, or even for acquiring a general knowledge of the 
industry, most careful planning of work is necessary. If all 
possible routine duties are attended to in the early hours, 
emergencies are more easily handled and time is more likely 
to be found for developing and improving the service. First 
aid room work increases and decreases with the seasons, with 
the pressure of work throughout the plant, with the weather, 
even with slight changes in factory routine or department 
management, so that at times there may be comparatively 
little to do. When these times come, the nurse, whose routine 
work is always finished at as early an hour as possible, will 
find leisure to study her problems and improve her methods. 

Getting the workers to return for redressings at the exact 
time they have been instructed to come will often be a diffi- 
culty. In one place this was overcome by giving a printed 
slip at the first visit. This slip the patient took to the fore- 
man who kept it on file and sent it back to the first aid room 
with the patient at each visit. The same paper served until 
the case was closed, when that fact was entered for the 
further information of the foreman. Sample slips follow: — 

2M, 19 48 

JUn Qloe, No. 233. Dept. 60. 
Remarks, S/ayi As Iro/e yoyylei yeileraay. 

Injured, 6\z4. 19/8, /o sJ. Nature of in j Ury , emery in cornea/. 

Incapacity, /w(da//y on/y fo-elay, iee doc/or'± rtfeort. 

Return to first aid room ? ye*. 

To return to Dr. at A. M. P. M. 

Send to first aid room 6\/s ^ at s stf. 

Ztf. Jf. £8., Nurse. 



Jim* 24, 19 48 

<J6vy 5/m#6, No. 35, Dept. 3. 

Remarks, Aid, uti// &ee fam<A/ dodo*. 

Injured, 4\05 & <Jt. Nature of injury, AAdn£* / /* 

Disposition, yi/en/er, Aenf dome lecauAe iic4. 

Incapacity, co?nfi/eie «/ fii^Aen/, ^rom t/Z/iexi net in/ury. 
Return to first aid rOOm ? on re/urn Id mil/. 
To return to Dr. at A. M. P. M. 

Send to first aid room viiOiny nu*&e 6> ca/t di* £P. *J£. 

Jt. Jt. <%.. Nurse. 

A new date for return is entered at each visit unless the 
case is closed, then "HEALED" is written diagonally across 
the sheet and it is sent again to the foreman. The returns are 
checked up by means of the day book and patients' individual 
cards which will be described. The careful following up of 
those who do not return when expected is a necessary part 
of the duties of the first aid room nurse, both for the safety of 
the patient and for the protection of the company from 
accusation of neglect or from possible unjust claims. The 
first aid nurse need not go to the patient's home but she 
should be able to send some reliable person. It is, however, 
more satisfactory for the nurse to go herself. A patient need- 
ing slight dressing might become ill from other causes and no 
home visitor would know the right thing to be done or do it as 
well as the nurse. In cases where there is doubt as to whether 
the illness had itsorigin from the injury, the nurse will see that 
the patient is again placed under the observation of the com- 
pany physician. She will be able to assist the foreman, the 
employment office and the compensation department by 


weeding out those workers who, having suffered a small 
injury, stay at home and, without notifying the employer, 
take work elsewhere or even move out of town. 

When workers are taken ill during working hours, the nurse 
will often be obliged to follow them to their homes in order to 
make sure of excluding contagion from the plant. Where no 
regular visiting nurse service is provided, the first aid nurse 
will have frequent reason to know that workers who should 
have help and advice are at home and not likely to get either 
unless their condition becomes alarming to the inexperienced 
family or indifferent landlady. 

Much interesting follow-up work, for which nurses find the 
need in the first aid room, must wait until a visiting nurse 
service is established. The nurse must return to a room full 
of workers who need prompt attention to avoid loss of time, 
idle machines, personal loss of money to piece workers, con- 
fusion in the departments of the plant and an upsetting of the 
whole system by which a busy day may go through without 
worry, haste or confusion. 

After a little experience, the first aid nurse will know about 
how many dressings she can do in half an hour, and the ap- 
pointments for the workers may be so arranged that time is 
not wasted. In some departments, it will be easier for the 
foremen to send all his people to the first aid room and have it 
over with. In other departments, where machines might be 
idle if several workers left, cooperation will be easier if the 
workers are allowed to come to the first aid room one at a 
time. These things can only be learned by experience in the 
industry itself. Thought and consideration in these matters 
will be part of the nurse's contribution to good team work. 
In opening a new first aid department, some confusion is 
inevitable, but much can be avoided by thought and, after a 
week or so, the return of patients should be so systematized 
that it is accurately accomplished with little trouble and 
almost no friction. 

For the quick handling of many small dressings, mostly 
fingers, the following plan works well. 



The automatic return of the patients having been assured 
and everything in the dressing room being ready, the clerk 
sits at a table near the door with the daybook, patients' 
individual cards, pad of return slips for foremen, duplicate 
book for writing notes to the company doctor, duplicate 
book for sending reports to the main office and any other 
forms that may be required by the particular plant. The 
clerk enters all names in the daybook as the patients come 
in, takes the slips which they have brought from their fore- 
men, and fills in the proper spaces in the daybook as the 
nurse tells her what to write. She marks the foremen's slips 
as directed by the nurse and has them ready to give to the 
patient as he leaves the room. In odd moments she will, 
perhaps, be able to assist in sterilizing instruments, in keeping 
the dressing table in order and in putting on some bandages. 
A few lessons in bandaging will interest her and the knowl- 
edge will be useful. In a busy room, however, the clerk will 
be fully occupied with the record table until the routine work 
is finished. 

The nurse stands between the stationary basin and the 
dressing table, the dressing table on her right. The dressings 
will then be done as rapidly as possible. Even so the nurse 
will find opportunity to teach the patients many things. 
Where the dressings are of a simple nature, it helps to have 
as many persons waiting in the first aid room as possible. 
There is little to be said about first aid, the necessity of 
prompt visits to the first aid room and the folly of neglect to 
use all safety devices provided, that will not be more im- 
pressive if heard by the workers in groups. The feeling, as 
the workers often say, that "the nurse won't like it" is a 
strong factor and not to be overlooked in maintaining proper 
discipline. Nevertheless, while this sort of publicity may do 
good in a mill or with young people, it is, doubtless, totally 
unsuited to some other industries or to people who are shy. 
It has no use or excuse in any dealings with the personal 
affairs of anyone. Where such groups are together nat- 
urally and comfortably, workers and nurse have a chance to 



become acquainted, the workers learn a good deal, especially 
as to what they must not expect the nurse to do for them, and 
the nurse, if she is not easily confused, enjoys the informal 

A conspicuous sign in the first aid room to the effect that 
the nurse will be in her office between twelve and one to see 
any one who wishes to consult her will make that a busy 
hour and will do much to leave the early hours free for the 
routine work of the plant. 

A sample page from a first aid room daybook will give an 
idea of what may happen during an average day in a plant 
employing five thousand or more. Purposely, a day was 
chosen in which no startling accidents occurred. Very serious 
injuries are uncommon in modern plants and, while almost 
anything may happen, such occurrences would make a day 
anything but average. The names are, of course, fictitious. 

Where a daily report is sent to the general manager, the 
main office or elsewhere, a book with duplicate pages and 
carbon paper permits the day's record to be used as it is for 
the report, while the carbon copy remains in the book for a 
permanant record and for use in writing up the patients' 
individual cards. 1 

The daybook is planned to record all that happens during 
the day: the patients seen, the treatments given, outside 
visits of the nurse, unless there is a regular visiting service, 
in which case convenience may require separate records and 
a special daybook for the visiting work. 2 

1 See Chapter X, Records. 

2 The National Organization for Public Health Nursing has devised 
an excellent system of day book and record card for visiting nursing 
which is adaptable to the requirements of many industrial nurses. 



Dallas Branch 

Cotton, Wool & Company 
First Aid Room 
Daily Report 

Dec. SSrd, 101S 

Time Return Name 











Spin 3 

No. Dept. 

J. Lee 

A. Brown 

B. Smith 

C. Coe 

H. Hoe 

M. May 
N. Kay 

C. Tate 

I. Butts 

F. Fay 
E. Day 

D. Wat 

D. M. Potts 

G. Kane 

Smith 123 
ce Brown, 8 
ret Conley 

House re C 
re J. Lee, 
F. Fay 

3 Spin. 

6 Dye. 

14 " 

56 Carp. 
87 Paint. 

98 Office 

6 Twist. 

90 Tool 
10 Test. 

97 Stenog. 

6 Fin. 

56 SP. 

Noman A 
9 Smith S 
978 Bush 

oe & Hoe 

Disability Disposition, Treatment, Remarks 

Crushed 1 f. L. 

Nail torn 
tip th. L. 

SI, burn top L. 

Burn L. eye 

Burn L. foot, si. 

Spr. ankle 

Lac. 1 f. L 


Emery, cornea, L 
Under weight 

Var. veins 

Went to T. B. 
Deserted by h 

Referred to 12 
Foreman will a 


Wet boric. To Dr. Chief. Caught 

in frame. 
Returned to work. — Accident 
at home, 6:30 a. m. 3% iodine, 
dry ster. 
Moist boric. Dye slopped. 

Flushed in dept. Wh. wine vin. 
Eye specialist. Emptying drum 

of caustic soda carelessly. 
Water, vin. B. A. Oint. 
Did not take time to put on 

boots. Caustic soda. 
As before. Order Dr. Chief. 
Massage, bandage. Order Dr. 


3% iodine, dry ster. Sharpen- 
ing pencil. 

Rest in bed, taken home. 

Brother had enlisted and left 
for Canada to-day. 

Sent to eye specialist. 

Left off goggles. 

83 lbs. Saw Dr. T. 12/21 Brought 

well planned lunch. Adv. as 

to habits. 
Bandaged. Surgeon adv. no op. 

Measure for stocking next 

visit 8 A. M. 
Clinio 12/21. To return l/7. 

usband, 2 ch., 1 & 4, at day 

Main St. re mother's pension. 
How time, P M. 

Following home visits made. 
See cards. 

Following parts of faotory 


See spec, report re goggles in 
Grinding Room, sent in dupli- 
cate to Gen. Mgr., Safety 
Dept., Head of Dept. and 
foreman of room after con- 
ference with head of dept. and 

The full number of cases for this day is not included. To 
save space, fifty-six first aid cases and redressings are omitted 
but those included are fairly representative. 

This is a good opportunity to say a word concerning special 
reports which may be made about conditions in different 



departments. The cooperation and good will of the depart- 
ment heads and of the foremen must be kept. For instance, 
in the case of the goggles mentioned above, there were not 
enough in the room to supply the men ; they had been ordered 
several times. The report was made to every one who could 
have any interest in the affair, after talking with the heads of 
the particular part of the plant. This conference placed the 
nurse in the position where she could help most. The wheels 
once in motion, the goggles arrived the next week. 

A daybook should be planned according to the size and 
organization of the plant. One at least twelve inches wide 
will be required to afford space for the information needed 
in every case. It should be bound at the top. 

A regular weekly schedule will help in making the work 
go smoothly and in assuring attention to easily forgotten 
details. It is helpful to have both daily and weekly schedules 
of work posted, both as reminders to the present force and 
for the information of others in case of a sudden change in 
personnel. The weekly inspection of other stations, the times 
at which first aid kits from outlying parts of the plant are 
to be brought in for replenishing, etc., should be included. 

The industrial nurse must not forget that, in the absence 
of the company physician, she is more interested in the first 
aid room than any one else, that every one in all other de- 
partments has his own work to do and that first aid will 
interest him less than his own duties except when he needs 
attention for himself or for a fellow worker. In whatever 
way responsibilities may have been delegated to others, it 
still remains the first duty of the industrial nurse to see that 
arrangements for the handling of any injury are not only 
made, but that they are maintained in a serviceable condition. 
Without carefully kept schedules, it is an easy matter to 
forget, in the pressure of daily duties, the inspection of the 
respirator at the fumigating plant or the renewal and prob- 
ably necessary dilution of the 3% iodine which was left 
with the foreman in the picking room to prevent trouble 
from the constant pricking of the men's hands. 



Where there is more than one first aid station a daybook 
should be kept in each, the person in charge writing down 
every occurrence and sending the original record to the nurse 
each day. By this means the record cards of all workers 
may be kept in the main station and the nurse is able to see 
just how much has been done in the other rooms. The last 
hour or hours of the day may well be used in part for calling 
up the outlying first aid stations, inquiring what has hap- 
pened and making sure that each worker, requiring attention 
from physician or nurse, has care while his whereabouts is 
still known. 

It is perhaps superfluous to repeat that, where a physician 
spends all or a regular part of his time in the plant, details 
of organization and routine rest with him. Most physicians 
are, however, glad to have some one arrange their work so 
that they are not obliged to spend time in waiting or in send- 
ing for workers. 

In some plants it is practical for the first aid nurse to spend 
certain hours only at the plant and for her to devote a good 
deal of time to home visiting. 

The keeping of records is so much a part of the day's work 
that it has been impossible to omit the subject entirely from 
this chapter. 




The records kept by the industrial nurse should be planned 
to aid her in meeting her fourfold responsibility: — to the 
worker, to the physician, to her employer and to herself. 

For the benefit of the worker, the full records in the plant 
should show what illnesses and accidents he has suffered 
during the period of his employment, what care and benefit 
or compensation he has had, what has been done to prevent 
future disaster, by improvement in his physical condition, by 
correction of his physical defects, or by changes in the con- 
ditions under which he works; together with the physical 
condition of the worker on employment, his educational 
advantages, his previous, experience, his home surroundings 
and bis working record. 1 

All this is possible for the industrial nurse working in a 
small plant who is able to interview each new worker, to 
visit his home, and who has also the privilege of sending 
patients at will to the company doctor. In a large plant 
this is only possible by routine physical examination of all 
new workers by a physician and home visits from the nurse, 
in addition to the closest cooperation in record keeping be- 
tween physician and nurse and with the employment, statis- 
tical and safety departments. 

The illness, accident, work, family and medical records, 
if kept together, present a picture of the worker which is 
often of great value to him and to the industry by making 
it possible to place him where he will do the best work and 
where he will, consequently, be happiest and most pros- 

1 See next chapter for employment records. 



The responsibility of the industrial nurse to the attending 
physician, whether the company physician or the family 
doctor, requires a complete account of the doctor's orders, 
of all the nurse does for the patient and of all she observes 
as to his condition and surroundings. 

The responsibility of the nurse to her employer demands, in 
addition to all the above, an account of how time and pos- 
sibly funds are used and a summary of results attained. 

To the industrial nurse herself the records are indispensable. 
They show her what she has accomplished, and sometimes, 
even more important, that which she has not accomplished. 
They aid her memory, prevent duplication of effort and make 
changes of personnel possible with the minimum of confu- 
sion; they make her work intelligent by giving her a picture 
of the worker in connection with his environment at home and 
at work. They are her best, and sometimes have been her 
only protection from unjust criticism and even legal complica- 

The proper coordination and interpretation of records is 
work for a trained statistician. Full description of methods 
of record keeping now in vogue would fill a volume. As the 
organization of industry for safety, efficiency and cooperation 
progresses, standards for all such records will undoubtedly be 
formed and more or less uniform systems will be evolved for 
the different industries. These problems should be taken up 
in unison by organizations interested in the prevention of 
illness and accident. With the coming of health insur- 
ance, state authorities may require certain standards for 
such record keeping in all industries. In the meantime 
each plant must work out its own system to suit its needs, 
utilizing the help and guidance of expert statisticians when 

A nurse, beginning industrial nursing, where there is a 
statistical department, should carefully plan out her own 
needs in the keeping of records and note the ways in which 
her records should be useful in connection with those of the 
employment, statistical and safety departments. 



It is a great advantage if the employer permits the indus- 
trial nurse to have access to the records of other departments 
which may add to her knowledge of the worker as an in- 
dividual and as a member of a family, and of the conditions 
under which he works, with their influence on his health and 
efficiency. Duplication should be avoided. After the nurse 
has clearly decided what records she needs, consultation 
with the employer will usually result in enlisting for her the 
cooperation of the other departments whose records may be 
used to supplement her own or in which her findings will be of 
value — the employment, statistical and safety departments at 

This interchange of records must not be allowed to affect 
the privacy of the personal affairs of the workers. The nurse 
will need memoranda here to aid her memory and to make 
much of her work of permanent use, but these things should 
be absolutely confidential and the workers should know that 
this is the case. 

Where the company physician is actually employed in the 
plant at regular times, he will probably have his own records 
which may supplant a part of the nurse's records or which 
may be supplemented by them. In a medical department 
with a physician in regular attendance the medical and 
nursing records should be kept in harmony and without 
duplication, but the final broad use of material gathered 
should rest with the physician unless he prefers to delegate 
such work to the nurse. 

The writer, not being a statistician, can only suggest to the 
industrial nurse methods by which she will be able to keep 
her own work in hand from the first day of her employment, 
without waiting for the development of all records necessary 
for full efficiency. 

We will assume that the nurse is employed to begin indus- 
trial nursing in a plant with the minimum of medical service 
from the company physician. 

Before taking up her duties, if there is time, she should ask 
to be provided with a daybook such as has been described in 



the last chapter. With the addition of some record cards in 
two colors, one color for industrial injuries and the other 
color for all other cases, the nurse will be able to keep an 
accurate account of all that happens in her department. 
She will need a small box with alphabetical guide for open 
cases and a filing cabinet for closed cases. If work must 
begin before printing can be done, a large blank book must 
serve as a record and the proper cards be made out as soon as 
they can be obtained. One card should serve a single worker 
for as long a time as possible, only a single line being used for a 
disability unless the patient is under observation for some 
time. 1 


Name Dept No Case No 


Date Hr. 


How injured 

Disposition or 

Dates for redressings, visits to 
Doctor, remarks 

The opposite side should be ruled and have column head- 
ings but no top heading. 2 

The record cards may be filed numerically or alpha- 
betically; if alphabetically, an accession book will be required 
for listing new cases, whether new individuals or additional 
occurrences to former patients; if numerically, an alpha- 
betical index should be kept. By either of these methods the 

1 A code for writing up cards is easily devised and is useful in saving 
space as well as for making the interpretation of the entries impos- 
sible for one who lacks the key. The common hazards may each be 
given a number, the common treatments a letter, departments a 
Roman numeral, etc. 

2 The cards should be a standard size, at least 5 in. X 8 in. 



total number of all cases may be found for any given time. 
The sum found in this way will prove or disprove the cor- 
rectness of many a report. 

A signal system of colored tags or crayon marks at the 
top of the cards will serve to classify them so that the total 
of any desired group may be obtained. Another way is to 
have a supply of cards of different colors, and guide cards. 
The name and identification of the worker together with the 
item to be classified is written on a card and is filed in its 
proper place. 

Suppose it were desired to discover at what hour of the 
day the greatest number of injuries occurred. The cards 
should state date, day, name, department and number, kind 
of injury and time. The guide cards would be marked with 
the time as follows: 7 to 7.30; 7.30 to 8; 8 to 8.30, etc. After a 
number of years such a record would yield material for an 
accurate report of the incidence of industrial injury as af- 
fected by time of day, day of week, occurrence of holiday, 
season of year. 

By means of these cross references, reports may be made, if 
desirable, of the comparative number of accidents in the 
different departments, the prevalence of certain illnesses in 
certain occupations, the comparative prevalence of injury 
under different speeds in similar processes or any special mat- 
ter about which the management is curious or which will 
help the nurse to point an argument. Elaborate records and 
reports require the attention of skilled clerks, but many little 
studies may be made by the nurse alone which will prove a 
point even though the requirements of the firm do not call 
for extensive record keeping. Any one with experience in 
industry, or even with a little imagination, will need no argu- 
ment as to the need and the uses of records in industrial 

In keeping the records it is needful to guard against the red 
rape which may defeat their purpose. In one plant the re- 
quirement that a worker, before applying for first aid, must 
have a long paper filled out by his superior and that he must 



give a good deal of personal history before being attended to, 
reduced the number applying for first aid from an average of 
forty to an average of ten a day. The number of infections 
increased at once. When the rule was changed the number 
applying for first aid became normal and the number of 
infections was at once reduced. The records made it possible 
for the nurse to point out the folly of making first aid a 
burden. The main thing is that the nurse should be accessible 
and that the workers should feel that they are welcome. 
Information required for records may be obtained in many 
cases during a casual conversation at the first interview. It 
might better not be obtained at all than that the worker 
should feel that anything exceeded in importance his own 

Some nurses with a statistical turn of mind might be in- 
clined to overdo the matter of records, but the common 
tendency is quite the other way. Most nurses are so busy 
that they are likely to neglect the record in favor of imme- 
diate service to the human being. 

It is not enough to do the day's work. Findings in the 
first aid room and in the homes should be checked up in the 
employment office with time lost and labor performed by the 
worker and in the statistical department for the preparation 
of comparative studies of different departments of the plant. 

Reports — Daily, Monthly, Annual: — In establishments 
where the nurse's records are tabulated and interpreted in 
another department, or where the nurse is employed by an 
organization of workers and where she is not the secretary of 
that organization and the records are kept in the office of the 
benefit, mutual aid or other association, daily reports of 
nursing work, either in the plant or in the homes, are often 
desirable. An employer will sometimes wish such a report 
solely for his own interest. The copying of daily records is 
unnecessary. If the daybook is arranged with duplicate 
pages and carbon paper, the original sheet, if carefully 
written, will, with a summary of the different totals at the 
bottom, answer every purpose. When this use is to be made 



of the daybook, care should be taken in planning it that there 
is space for all information desired both by the nurse and by 
the other interested departments. Patients calling on the 
nurse for advice in personal, confidential matters may be 
listed without detail as "Personal." 

The following is a monthly report 1 from a plant in a small 
town where local public health agencies were lacking or 
undeveloped and where a good deal of public health work was 
done by the industrial nurses, who lived in a nursing center, 
attended to the first aid work in the plant under the direction 
of physicians, and carried on visiting nursing under the aus- 
pices of the employes' benefit association and under the di- 
rection of the family physicians of the patients. 

The work at the nurse's residence was confined to nursing 
activities, the town being well equipped with other social, 
educational and recreational facilities. 

The yearly report may be easily made up from the monthly 
reports. At regular but not too frequent intervals, every 
three or six months or yearly, a nonstatistical report affords 
an opportunity to take account of progress or lack of prog- 
ress, to search for hampering conditions and to point out 
possible means for improving the usefulness and efficiency 
of the nursing service. Such an account of work done or 
contemplated will do much to keep the nursing department 
from stagnation, the nurse from possibly unwarranted self- 
satisfaction and cannot be wholly without interest to the 

1 In the monthly report illustrated, columns 2, 3, 4, 6, 7, 8, 9, and 11 
are filled in by the nurse; Columns L, 5, 10 and 12 are provided by the 
employment office and by the office of the Mutual Aid Society. 




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The number of interesting and useful ways of presenting 
information easily obtainable from well-kept industrial nurs- 
ing records is large. The writer has only tried to point out a 
few possibilities. A thoughtful nurse in any industry will 
see numberless ways of using her records, not only for her own 
information and benefit, but for the benefit of worker and 
employer as well. 

The Records of the Visiting Industrial Nurse: — The records 
of the home visiting should be closely coordinated with 
those of the first aid room and with the employment office, 
where cooperation with that department is allowed. A 
description of a system of combined records for the use of the 
industrial nurse who is also in charge of the employment 
office will be found in the next chapter. Where all the 
records of each worker cannot be filed together, the visiting 
nurse can easily modify any good system in use by a visiting 
nurse association, or that advocated by the National Or- 
ganization for Public Health Nursing, to suit her needs. 

The visiting nurse will need a daybook in which to record 
the story of each day. A duplicate page book is useful and 
time saving. The original sheet may be used by the person 
responsible for writing up the cards and may afterwards be 
sent to the person wishing a daily report, while the duplicate 
remains as a record. Bedside notes for use in the patient's 
home in recording the orders of the physician, the condition 
of the patient and the work of the nurse must not be forgot- 
ten. Where written orders for the care of the patient can be 
obtained it is wise to preserve them on file in their original 
form, with the other papers concerning the patient. 



Employment management offers a field of service for women 
in which their peculiar fitness is being increasingly recognized. 
It is an opportunity for the nurse who has had experience in 
industry. Close connection with the " hiring and firing" 
of a large establishment, and personal interviews with ap- 
plicants for employment — with the nurse's opportunities 
for getting a full home, health, work and educational picture 
of the worker — and a system of interviewing all who leave, 
will reveal much avoidable inefficiency with consequent 
lessening of production. Causes for the dissatisfaction of 
employes are found and resulting needless "labor turnover" 
is reduced. Employment managers throughout the country 
are succeeding in reducing this labor turnover and in in- 
creasing the efficiency and contentment of the workers, so 
benefiting both them and the industry. Nurses, as well as 
other educated women, are filling such positions and should 
continue to fill them in increasing numbers, especially in the 
industries where many women and girls are employed. 

Service in the employment office, either as manager or as 
assistant manager, is a logical development of the earlier 
and better known contributions of the nurse to industrial 
welfare. Her earlier contacts with industry aid her, if she 
is otherwise prepared for her new duties, in becoming an 
employment manager of exceptional value. Courses of 
study in preparation for this work are being offered in several 
colleges. Lacking a special theoretical training, a nurse, 
serving an apprenticeship in a well-managed and successful 
employment department as assistant or otherwise, would 
gain an insight into the necessary procedures and records 




which, in addition to a familiarity with industry already ac- 
quired, should enable her to assume the control of such a 

The work of employment management, as understood in 
most modern organizations, includes much that has been 
known — sometimes to its disadvantage in the estimation of 
the worker — as welfare work or welfare supervision. Such a 
department is now, more accurately, frequently called a 
service department. While its main function is to provide 
for the plant a sufficient number of healthy (or sufficiently 
healthy) and contented employes who are fitted to do the 
work required in an efficient manner, a secondary function 
is to reduce the labor "turnover" and the resulting expense 
of training new workers with their increased liability to in- 
dustrial injury. The conception of the work, however, as 
held by many employment managers is that of a public 
service to the community, and its opportunities quite justify 
them in holding such an ideal. 

In those plants so fortunate as to have a physician in con- 
stant attendance, his work will naturally be closely associ- 
ated with that of the employment department. In such a 
wide reaching medical department, the industrial nurse is 
of special value in the employment office as assistant to the 
physician in his interviews with the patients, in the proper 
recording of his findings and in the many other ways in which 
a nurse is accustomed to aid a physician. 

At the present time nurses are more frequently working 
at employment problems in small establishments where 
there is no separate employment manager. A more or less 
informal employment department is sometimes developed 
in connection with the already existing nursing service. Any 
plant, where the physical examination of employes by a 
physician is not a routine measure, will gain in the health of 
the workers and in their contentment and efficiency, to say 
nothing of freedom from claims (*) for injuries which oc- 

1 Honest persons have been known to be unconscious of defects until 
attention was called to them by some accident. Men have been found 


curred elsewhere, by the help of a nurse in the employment 
of new workers. 

' The consideration of a large employment office will not 
be attempted. A nurse contemplating the management of 
such a department would either grow into it from a small 
beginning or should take steps to prepare herself for the work. 

While the first thought might be that the employment 
department will select workers, the truth is that selection 
of workers is now largely a thing of the past, along with our 
former stream of immigration. Fortunately for those who 
seek work, and indeed for the employer also, the problem, 
in these days, is often fitting the applicant to the work which 
must be done or even fitting work to the applicant. This 
means ceaseless instruction and a large outlay of actual 
money in the acquisition of each new employe*. By the exer- 
cise of judgment and the use of records in the employment 
office, it is possible to do much toward retaining good em- 
ployes and toward fitting new ones to their work. Some firms 
make it a practice not to refuse employment to any one ca- 
pable of doing work, except where the presence of infection 
or the existence of epilepsy would render such employment 
dangerous. Many employers are willing to go to a good deal 
of trouble to assist an applicant in overcoming his handicap 
or in finding a cure for his disease. Furthermore, it is being 
recognized that certain handicaps are attended by no dis- 
advantages in some occupations. Deafness often helps at- 
tention when the work demands close application. There 
are occupations in which even the blind excel, such as work 
requiring sensitive touch rather than keen eyesight. Even 
years are not the disadvantage they were considered for 
some time after Dr. Osier's unfortunately misunderstood 
remark. Women of mature years and high character have 
a steadying influence on the girls with whom they work, 
and are found to be a distinct force in making undesirable 
who were blind in one eye and who had no idea of the fact until told 
by the examiner. Defects of hearing in one ear may entirely escape 
notice. An explosion might cause such a person to assign it as the 
cause of a defect of long standing. 



women uncomfortable in the company of those of better 
morals and in causing their quiet elimination from the plant. 
Old men have had a chance to show that they have quali- 
ties lacking in younger people and have reentered industry 
in considerable numbers since war demands have taken so 
many of the younger men. 

Now that so many of our soldiers and sailors are returning 
to civil life maimed and crippled, patriotic employers every- 
where are searching for suitable positions for the handi- 
capped. The industrial physician and nurse help to dis- 
charge the debt of the nation when they make it possible 
for one of these young men to take up again a useful life of 
productive labor. 

The possibilities of service from handicapped labor are 
understood but by a few at present. Mr. F. B. Gilbreth 
by his motion studies is doing much to promote a knowledge 
of the necessary movements to perform certain actions, but 
so far but a comparatively small number know of his work. 
He has suggested that a dental nurse (an occupation which 
he proposed to relieve the more highly trained dentist of 
simple work such as cleaning teeth) can be deaf, one-eyed, 
one-armed and legless and yet be efficient. 1 It requires little 
imagination to conceive that a traffic officer may be one-eyed, 
one-armed, and legless without materially interfering with 
his work. Frequently a very simple appliance or change in 
the form of an implement will enable a cripple to do quite 
complicated work. Through the publication of pictures of 
crippled soldiers at work this knowledge is becoming more 
general. A number of examples are illustrated in Dr. W. R. 
Dunton's "Reconstruction Therapy," Chapter XI, Pros- 
thetic Appliances. 

The fact that a worker is conspicuously handicapped will 
frequently urge him to every effort to show his appreciation 
of the consideration given him. When the applicant suffers 
from a curable trouble advice rather than material relief 

1 A New Occupation for the Crippled Soldier — The Conservation of 
the World's Teeth. Trained Nurse and Hospital Review. 


will often make it possible for a formerly inefficient worker 
to hold a good "job." Service of this kind need not mean a 
large expenditure for the actual care of strangers. Until the 
state assumes responsibility for the health of everyone, it 
must continue to be the duty of all who are in a position 
to discover the physical shortcomings of others to, at least, 
suggest the first steps necessary in the search for health. 

Inquiry into the previous education and experience of 
applicants, instead of giving them, without question, the 
work for which they ask, will often discover good workers 
for a much higher grade of labor. High school graduates 
have been found running errands while the office force needed 
clerks and while young people were wanted to train for good 

Numerous psychological tests are in vogue for discovering 
the mental capacity of workers with a view to aiding their 
advancement. Some employment managers use such tests, 
but the proper interpretation of the results is of so technical 
a nature that their usefulness is questionable unless employed 
by a psychologist. 1 

The initial interview with the applicant by the nurse will 
attain many desirable results. Findings made permanently 
available in the records will be of daily use in making changes 
in the force to allow for the varying demands of the different 
departments. They will show which workers, not required 
in one department, can be made available for the different 
duties of another department, temporarily busier, thus avoid- 
ing the practice, wasteful both to the employer and to the 
employe", of laying off workers in one section while advertising 
for help in another. 

Strange surroundings are less confusing when the worker is 
met by a responsible person whose business it is to see that 
he has some one to teach him his new duties, explain to him 
the provisions made for his safety and comfort, together with 

1 "There is as yet no secure scientific method of testing applicants." 
"Industrial Loyalty, its Value, its Creation, its Preservation," Boyd 



the precautions expected of him, and who puts him in charge 
of another worker who will take him to the lunch room at 
noon and introduce him to some of his future associates. 

The nurse, as employment manager or working in the em- 
ployment office, should learn the particular needs of the 
workers. She should learn as much as possible of the proc- 
esses at which women and girls work and should be able to 
state accurately if they involve too much strain, and show 
why such is the case. She should understand the work re- 
quired of the men and the boys. Without this knowledge 
she will make mistakes in placing workers and she will not 
be able to speak convincingly in her efforts at adjustment. 
The nurse employment manager or assistant employment 
manager may be expected to be responsible for the general 
behavior of the women and girls except in the technical de- 
tails of their work. She may be expected to look after the 
maintenance of healthful conditions in the plant as to cleanli- 
ness, light, warmth, ventilation, moisture, etc., by keeping 
the management informed as to her observations. 

In some plants a representative of the employment office 
calls at the home of each new worker, especially young people, 
in order to make the acquaintance of the parents and to pro- 
mote mutual friendship and helpfulness. The industrial 
nurse, in the employment office as well as in the first aid 
room, should be able to provide information to workers as 
to housing, boarding and rooming places for men and women, 
hospital and dispensary facilities, night schools, day nurser- 
ies, means of transportation and many other matters which 
will appear in her daily contact with the workers. 

There should be opportunities to study the health of the 
workers in relation to their efficiency. If the management 
will allow the nurse to keep in touch with the paymaster's 
department, she can watch the wage sheets of the workers 
and will often find a steady decrease of earnings an early 
indication of failing health. With information obtained from 
the timekeepers the nurse in the employment office of a 
small plant or through the visiting nurse of a large organiza- 


tion will be able to point out inadequate means of transporta- 
tion, unreasonable distances to be traveled and many other 
matters which might be adjusted for the benefit of the work- 
ers if the employer's attention were called to the exact need. 
A report from the industrial visiting nurse of the necessary 
expense of living was known to cause one employer to raise 
materially his minimum wage. 

The industrial nurse must not be exploited in the dismissal 
of employes. If she finds the physical condition of the worker 
such as to make rest advisable, she should be able, with the 
cooperation of the family doctor and the worker's family or 
friends, to advise or assist the sick person to get proper 
medical care and to make it possible for him to take the 
necessary treatment. Most workers, who see what seems to 
them a practical way of overcoming their ill health, are willing 
to stop work and to make the effort to get well. The nurse 
can arrange matters with these workers so that resignation 
will be voluntary, reemployment depending on improved 
physical condition. 

No dismissal of an employe for cause or for the reduction 
of force should be imputed to the nurse. This must be con- 
tinually guarded against. Foremen wishing to get rid of a 
worker will sometimes unthinkingly involve the nurse, with 
no real reason for doing so. If the nurse has been instru- 
mental in proving the inadvisability of the continued em- 
ployment of any worker, justice to the worker and to the 
nurse demands that she have an opportunity to talk with 
the employe and make plain to him just why other work 
will suit him better. No worker should be turned away 
without being made to feel that sympathetic consideration 
has been given him and that, if he were suited to the employ- 
ment, he would like to work for a company showing him such 
kindness. Neither should a worker or applicant be turned 
away without thought as to his next "job." If no work can 
be found in the plant for an applicant, he should be told if 
possible where to apply for employment. It may even be 
worth while, in some instances, to find a position for him. 



With the development of noncommercial local, state and 
federal employment bureaus, it is becoming easier in many 
localities to place applicants for work where they will be 
able to use their talents to their best personal advantage. 

An interview with each departing employe - is important 
in order to obtain a record of why he thinks he is discharged 
so that comparison may be made with the reasons given by 
those discharging him. This also affords an opportunity 
to discover why the worker who leaves of his own accord is 
dissatisfied with his "job." Much tact is sometimes required 
to get this information, but the findings are often well worth 
recording and tabulating. 

The industrial nurse, in the employment office, first aid 
room or visiting in the homes, who gives and obtains good 
cooperation should have through her records something of 
value to offer in the study of the relation of hours of work 
and of fatigue to illness and to injury as well as to output; 
in the effect of speeding-up on the number of injuries and 
on the endurance of the workers; in showing the economic 
and health value of proper lunches and of regular periods of 
rest; in pointing out the consequences of the employment of 
expectant mothers and of mothers of little children, es- 
pecially with regard to the prevalence of miscarriage and 
infant mortality; as well as in searching out the less obvious 
health and accident hazards. 

The record cards and blanks illustrated are in actual use 
by nurses working in connection with the employment of 
labor. They will prove suggestive to one who must devise 
such conveniences and who has no precedent in beginning 
a record system. The forms shown are specially adapted 
to the needle trades and will require modification for any 
plant. If all the cards are uniform in size they may be filed 
together during the employment of the worker. 

The description of other printed matter is also intended to 
be merely suggestive, some plants requiring few forms and 
others with many departments having entirely different 
needs. The industrial nurse beginning alone or with little 


assistance should guard against a multiplicity of forms and 
blanks which cannot be properly used for lack of time. It 
is easier to ask for additional forms when their need is evi- 
dent than to explain why a large number of blanks provided 
in the beginning have not been used. 

The outline for the first interview, while suggestive, will 
probably be exactly suited only to the plant for which it was 
devised. The outline for the observation of the physical 
condition of the applicant by the nurse is in no sense intended 
to supplant a medical examination by a physician. It is 
merely a guide to the observation of conditions which might 
indicate consultation with the physician in those plants not 
providing medical examination of all applicants as a matter 
of general policy. 

The observation of the physical condition of an applicant 
need not be very prolonged. Much may be observed while 
talking to the person. If the nurse explains as she proceeds 
that the eyes are examined so that the applicant may not 
be given work injurious to defective eyes, that the ears are 
examined to make sure that the worker is able to hear sig- 
nals in connection with his work and if the nurse has a reputa- 
tion for being able and anxious to help people, there will be 
few if any who will object to this interest in their welfare. 
In this field as in all others the nurse should carefully guard 
her reputation. Opinion is easily formed and hard to change. 
Years of thoughtful care and work for others may not enable 
one to entirely live down even one hasty and ill considered 

Care in observing the symptoms of weak arches and in 
finding varicose veins is of importance in assigning em- 
ployes to work which requires much standing. Proper sup- 
port for a part of the time with suitable exercises or other 
treatment should make the flatfooted more able to do general 
work and the afflicted applicant should be told the im- 
portance of seeking a skilled practitioner for diagnosis and 

The many people who suffer from varicose veins and who 



have no idea of how to care for them is surprising. Once the 
opinion of a surgeon has been obtained and it is decided 
that support only is indicated, the care of such sufferers is 
surely work for a nurse. There is nothing a nurse can do 
which will be more appreciated than the teaching of those 
having varicose veins how to keep them supported while 
standing or sitting, impressing on them the advantages of a 
recumbent position whenever they are resting, and relieving 
them of anxiety by instructing them as to what should be 
done in case of rupture or if an ulcer should appear. 


Blank and Company 
9 North Fifth St., Seneca, Cal. 

Service Department Date 

Name in full 

Address Telephone Number 

Place of birth Date of birth 

Married, single, widowed .... Do you live with parents? . . 
Education (give details of highest grades attended) 

Do you attend evening school? 

What studies are you pursuing? 

Position desired Salary expected . . . 

Have you ever done such work before? 

Where When Position held 

Name and address of last employer 

Position held How long employed .... Salary. 

Date of leaving Reasons for leaving. . . 

Name and address of previous employer 

Position held How long employed .... Salary 

Date of leaving Reasons for leaving 

Other business experience 

If we are unable to give you the position desired at once, 

what position will you take temporarily? 

Recommended by . . . adv. . . . sign .... employment bureau 
References: Names and addresses of at least two, other 
than relatives 



Applicant interviewed by 

1 Print on card uniform in size with other cards. 



Blank and Company 
9 North Fifth St., Seneca, Cal. 

Service Department Date 


Gentlemen : 

Mr. Mrs. Miss has applied to us for a 

position as stating that was in 

your employ as from (date) in 

Dept., under Mr Foreman; 

and that left (date) Any informa- 
tion you may give us regarding will be treated as 

strictly confidential. 

Was .... employed by you for the period above stated?. . . . 

f Good? 

SkilH Medium? 

[ Bad? 

f Fast? 

Production \ Medium? 

[ Slow? 


At what class of work does applicant excel? 

Remarks : 


Thanking you in advance in anticipation of a prompt 
reply, and assuring you of our willingness to reciprocate, 
we are 

Yours very truly, 
Blank and Company, 
Service Department. 

Copy of application for employment for filing in waiting 
list and for use as a cross file after employment. 

No .... Service Department Date 


Address Telephone No 

Age Nationality Single, Married, Widowed 

Similar work elsewhere? Where? 

What process? 

Name and address of last employer 

Of previous employer 

Father's name Nationality 



Name Citizen? 1st papers 2nd papers. . 

Address Telephone No 

Place and date of birth 

Relatives living? Father Nationality 

Mother Nationality 

Brothers Sisters Children (sex & ages) 

Wife Employed Where 

Hus Employed Where Citizen?. . . 

Wage Earners 

School Training: yrs. in U. S yrs. abroad Grade in U. S 

Date of immigration English, Speaks Reads Writes.. 



Last employer? Why left? 

Previous employer? Why left? 

Assigned to Dept No 

Opera tion Wage Date 

HOME: Live at? No. Rooms No. occupants Boarders 

Sanitary condition 

Home visits by nurse (1st & last at each absence) 


In case of accident notify 

Possible transfer to — Purch., Op., Stock, Design., Exam., Sales, Cut., Trim., Press., 
Ship., Mach., Clerical 

1 Large cards — 5 in. X 8 in. 


Reverse side of personal record card. 

First Aid Room Name Dept. 




How injured 

Disposition or treatment, 

Home visiting 



Dates of visits, services rendered, remarks 

Home visiting records may be kept on the reverse side of 
the personal history card. Supplementary cards ruled on 
both sides for first aid and for visiting nursing will provide 
extra space. 

Where the nurse is permitted to gather and use the in- 
formation indicated, this card or one modified to suit the 
industry will give a fair history of the worker, with the 
exception of his attendance and work records, which cannot 
be included unless the management allows the cooperation 
of the timekeepers and of those keeping the wage sheets. 

A numerical file is necessary for filing the names of the 
workers by their identification numbers. This requires only 
name, department and number of each worker. A daybook 
for those applying, discharged and engaged will make possible 
the making up of monthly and weekly reports without tire- 
some sorting of cards. 


The card, for the requisition of employe's, states the re- 
quirements of the department and affords a record of the 
disposition of new and of the transfer of old employes. 
Plate A. 

A wage and time card ruled on both sides will give a record 
of the hours worked and of the earnings of an employe for 
two years. Plate B. 

A report devised to fit the industry and affording the 
information suggested in the following form will make possible 
the comparison of different departments and of the different 
years in the same department. Plate C. 

An employer establishing or reorganizing a service de- 
partment may expect the industrial nurse to suggest forms 
for other uses, such as identification cards and passes. Visit- 
ing cards, for the use of a nurse visiting in the homes or 
acting as a representative of the company in any capacity, 
are almost a necessity. 


Blank and Co. 
9 North Fifth St., Seneca, Cal. 

Identification Card 

Name Clock No 



Height Weight Hair 

Eyes Complexion Beard 

Mustache Signature 

Employe Service Department 



Please furnish the following. 




Week Work 









Desired Qualifications. 

Age between 


Other points 



.Increase In Force. 

To Mr 






If applicant Is satisfactory Insert only the date effective and rate and return to Service Department 
with signature. 

If applicant Is not satisfactory, show reason, sign opposite No. 1 and return In envelope to Service 



I En gagement 

I Re-Engagament 

I Ro-lnstatement 

I Transfer 


I Private Payroll 

I M'n'f'g Payroll 


Signature 1 .. 












Return to SERVICE DEPARTMENT at once. 
Plate A 





















































































































I I I i -i 

' L » 






a & 
© - 


© « 

_ k 

•s v 
« i- 
a < 

fa B 

fa s 





Z E 









w O 

£ O 

o: X 

a> c <o 

§ 2 .sp i 

ts 2 -t 

« (DO. 

•5 3 

Plate C 



Blank and Co. 
9 North Fifth St., Seneca, Cal. 

Pass Out 191. . 

Name Clock No at A. M. 

P. M. 


With following articles 

Dept. . 


Miss Jane A. Smith, R. N. 
Visiting Nurse 


Mutual Aid Society 
Employes of Blank and Co. 

A printed list of the conveniences, comforts and special 
advantages provided is sometimes given to each new em- 

BLANK & CO., 9 North Fifth St., Seneca, Cal. 


We desire to make this establishment a most desirable 
place to work in, and to that end we maintain a Service 
Department, the object of which is to supply every com- 
fort, convenience and safety to our employes. 

1. We have a Service Director, a trained nurse, who 
devotes her entire time to overseeing our service to em- 

2. In cooperation with the City Public Schools, a class 
ia maintained at the factory each day for the purpose of 
teaching the reading and writing of English to those who 

1 Copied almost verbatim from a circular used by Mrs. Claribell Hill. 


have need for it. The Board of Education supplies the 
teacher, and the firm pays the girls for their hours in our 

3. In cooperation with the City Board of Health, a 
series of health lectures is given in the Recreation Hall 
at the noon hour. 

4. A first aid room is provided for employes who are 
sick during business hours, with a trained nurse in attend- 

5. A trained nurse visits sick employes in their homes if 

6. The Service Director may be called upon confiden- 
tially for aid or advice in personal matters. 

7. A lunch room is provided where employes may pur- 
chase wholesome food at cost prices. 

8. A Recreation Hall is provided. Dancing and music 
are enjoyed here during the noon hour. A piano and pho- 
nograph have been installed for that purpose. 

9. A free circulating library, a branch of the City Public 
Library, is maintained for the convenience of employes. 

10. Current magazines will be found on the tables m the 
Recreation Hall. 

11. Librettos and books on the operas may be bor- 
rowed when desired. 

12. Special entertainment is furnished from time to time 
at the noon hour. 

13. A dancing class is in session one noon a week where 
modern social dancing is taught. 

14. Lectures are given twice a month at the noon hour 
in the Recreation Hall. 

15. A popular Song Review is held once a week under 
competent direction. 

16. A gymnastic class and a class in folkdancing are 
held once a week at the noon hour with a competent in- 
structor in charge. 

17. Dumb-bells, wands and a punching bag have been 
placed in the Recreation Hall, for the use of the employes. 

18. A dressmaking class is held in the Recreation Hall 
one evening a week, under the direction of a teacher. A 
charge of fifty cents is made for five lessons, equipment 
being furnished by the firm and materials by the pupils. 

19. A Vacation Fund is maintained where girls may 
deposit small savings toward their vacation expenses. 

20. Bulletin boards are placed throughout the factory 
where notices and items of interest are posted. 

21. Any employe who first suggests an improvement or 
any feasible plan for economy of any nature will be paid 
$2.50 for each suggestion adopted. 

22. A supply of umbrellas is kept for the convenience of 
employes which may be rented for five cents a day when- 
ever needed. 


23. A supply of stockings is kept for the convenience 
of employes which may be purchased t for ten cents a 

24. All employes are given the benefit of wholesale prices 
on merchandise bought for personal use. 

25. A monthly paper is published by and for the em- 
ployes. "Threads and Thoughts," subscription price, 
twenty-five cents per year. 

26. Several evening entertainments are given during 
the year. 

All Work of the Service Department is Done by 
Committees of the Employes in Cooperation with 
the Service Director 

Cooperation means success. 
Please be quiet. 

Do not make unnecessary noise in halls or on stairways. 

Please be careful. 

This is your business home. Be careful of it and keep it 
clean. Do not mark or deface walls or fixtures. 

Please be orderly. 
If you use a thing, return it to its proper place. 

Please be reasonable. 

There are nearly 600 people in this building who have 
the same privileges that you have. Do not do any- 
thing that would not be right for every one of them 
to do. 

Please be clean. 

Do not spit on floors or stairs. Spitting in public places 
endangers your life and the lives of your fellow work- 
ers. It is prohibited by the Board of Health. 

An outline for the observation of the physical condition of 
the applicant for employment follows. If the items are 
printed on a card uniform with the other record cards and if 
the questions to be answered by the applicant are printed 
no the reverse side, a permanent record for filing is 

In planning a card for this purpose, if there is a physician, 
other than the family doctor, to whom the nurse is permitted 
to send cases which she thinks should be passed on by a 
doctor, he should be consulted and he would undoubtedly be 
able to make valuable suggestions. 



Colored, White, Male, Female Married, Unmarried, Children With parents 

Name Address Age 

Height Weight Age on entering industry 

T P R Mouth Nose Throat Eyes 

Feet Corns Bunions Swelling Foot gear 

Legs Scars Varicose veins Swelling 

(Edema Eyelids Legs Def ormaties 

Evidence of former injury visible 

Eyesight both r 1 Colorblind 

Hearing both r 1 fU.R. 12345678 

Unsuited to Teeth i U - L - 12345678 

L.R. 12345678 

L. R. 12345678. 

Remarks . 

Applicant observed by Nurse 

Ex. by Dr Statement 

Reverse side of card. 

Name Date 

Have you ever had any of the following diseases? Fits 

Lung trouble Rheumatism Rupture 

What illnesses have you had? 

Have you any physical defects? 

Signed Applicant 


Employed Waiting List Rejected 

For observation 

To reapply after treatment After treating head 

With proper shoes Suitable dress 

Certificate from Dr 

Medical history after employment, Transfers, etc 

Ear tests may be made with a " dollar watch." Standard 
cards for testing eyes, with instructions for their use, are 
obtainable from dealers in optical supplies free of charge 
or for a small sum. Color blindness may be tested with 
a card of sample colors to which the applicant matches 
small bits of the same colors. There should be several shades 
that do not correspond with the primary and secondary 


colors on the sample card. Those shades intended to match 
should match exactly. For workers who will be expected to 
match delicate shades special tests will be required. 

The first interview with the new employe is so important 
that an outline should be prepared which may be kept on the 
nurse's desk so that nothing may be forgotten. 

Outline for the First Interview with the New Em- 

I. Responsibility of the organization toward the worker: 

1. Earning opportunity: 

(a) Hours of work. 

(b) Minimum starting wage. 

(c) Wage system (piece, rate, task, etc.). 

(d) Basis of promotion. 

2. Regularity of employment: 

(a) Providing of work and of exact positions. 

(b) Scientific assignment of workers according 

to need. 

(c) Teaching each worker several occupations. 

(d) Security of position. 

3. Policies and methods of cooperation. 

(a) Purpose of service department. 

(1) Adjustment of difficulties. 

(2) Cooperation in the development of 
mental, physical and social well-being. 

(b) Purpose of instruction department. 

(c) Purpose of other departments. 

II. Responsibility of the worker toward the organization: 

1. Responsibility for the maintenance of proper 
physical and moral conditions: 

(a) Value of neatness and order in surroundings. 

(b) Wholesome moral atmosphere. 

(c) Plain business dress and courteous manner. 

(d) Democratic spirit. 


2. Regularity of attendance: 

(a) One worker for each position. 

(b) Care of health with the aid of factory med- 

ical department. First aid, visiting nurse, 

(c) Importance of home hygiene. 

(d) Importance of the avoidance of outside 


(e) Importance of regular hours and wholesome 


III. The importance of character: 

(a) Essential to fitness and advancement. 

(b) Reasons for giving proper notice when quitting 

(bonus for notice). 

(c) Necessity for being patient and reasonable and for 

giving work a fair trial. 

(d) Frankness and promptness in presenting com- 

plaints and criticisms. 1 

The correspondence of an employment office or of the 
nurse's office should be carefully filed. A convenient method 
for keeping the letters and other papers concerning any one 
employe with his other records is by means of a heavy manilla 
envelop of a size to match the record cards, having printed 
across the eight-inch side a space for the name, department 
and number of the worker. Where there are papers to be filed 
for only a few of the employes this method is sufficient. 
Where there are many papers for each sick worker, as when 
the visiting nurse delivers the sick benefits and keeps receipts, 
the envelop may be printed on both sides like the form for 
lower part of the reverse side of the personal history card. 
The outside of the envelop may then be used for visiting 
nurse records. 

1 This outline for the first interview with the new employ^ is taken 
almost verbatim from an address by Miss Mary Gilson, delivered at 
the Employment Managers Conference, Philadelphia, Pa., April 2 and 
3, 1917. Bulletin of the United States Bureau of Labor Statistics 
Number 227. 


The employment department must be " built on a founda- 
tion of records " ; the system must be just elaborate enough to 
give a complete picture of each worker and no more. The 
simpler the files the less chance of misfiling. A misfiled record 
may almost as well be lost. The records must be kept up to 
date as to the disposition of the workers, their hours and 
earnings and especially their change of address. The plan of 
having each foreman responsible for sending change of ad- 
dress to the office on the second 1 working day of each month 
seems to be the best way of keeping track of the, too often, 
frequent moves of the workers. If the person making a report 
of the illness of a worker can be made responsible for getting 
the correct address at that time, many fruitless errands will 
be avoided. 

The records of the employment office as well as those of the 
first aid room and of the visiting nurse should be confidential. 
They should not be allowed out of the department, should be 
seen only by those having business with them, and should be 
kept in a locked case or in a locked room. 2 

1 People are apt to move on the last or the first day of the month. 

2 A code system is useful for many entries. See Chapter X. 



Where one industry is responsible for the growth and 
existence of a town, the employer sometimes makes provision 
for more or less extensive public health and social work for 
the whole community. In some industrial villages this is 
done through a division of responsibilities, specially trained 
workers being in charge of each branch and the schools, 
recreation center, nursing center, etc., in separate buildings, 
or at least each one under the control of teacher, social 
worker, nurse, etc. In other industrial villages, schools, 
nursing, recreation and other activities are conducted from 
the same building with teacher and nurse as residents, 
cooperating in the management of recreations and other 
activities with the help of workers from the plant. Where the 
local authorities have the schools, recreations, care of public 
health, etc., in hand, the owner of the principal industry 
may still provide a nursing or health center of some sort. 
The center in many small industrial villages consists of a 
company hospital from which nursing and social work to a 
greater or less extent, is carried into the homes. The com- 
pany hospital, however, has little use except in isolated com- 
munities where no general hospitals are available. Many 
employers and most employes consider that better general 
and special care is obtainable where the foremost physicians 
and surgeons are on the staff of a local hospital rather than 
in one controlled entirely by an industry. 

Where no industrial hospital is necessary, a nurse's house 
is, in some towns, used as headquarters for all industrial 
nursing work. Often living quarters for the industrial nurse 
and her assistants are included. With a house of this kind, 



many neighborhood activities are possible and, if there are 
no local agencies for public health education and social 
welfare, almost any recognized social measures may be 
handled, at least temporarily, by the staff of resident or non- 
resident nurses. If one nurse at least has social training and 
experience and has the social view point, social needs may 
be recognized and demonstrated and temporary or per- 
manent methods for meeting them devised. 

The only apparent drawback to the plan of a nursing center 
or nurse's house where the nurse lives is that the industrial 
nurse, especially if she is without assistants, will find little 
time for uninterrupted rest or for relief from the ever pressing 
affairs of other people. There must be some means of 
escape for the nurse, or fixed and regular times when she is 
"not at home. " This is hard to manage. Neighbors cannot 
understand how anything can be more important than their 
own affairs, and if the nurse or her employer lack a sense of 
relative values, the nurse may find that she is using time she 
needs for rest, and much of her reserve strength, in work 
which, while comforting at the time to the person helped, is 
often of little real or lasting value. 

If the staff is large and the employer willing, work may be 
so planned that it is possible for a nurse to sit up all night with 
someone beyond help or to assist a family physician with 
minor operations on Sunday or to attend an obstetrical case 
at whatever time she is needed. But the staff is seldom large 
enough for these demands and if the nurse allows her time and 
strength to be unduly taxed, her work in the plant and that 
which her employer expects of her in the homes, in addition 
to her own health, are sure to suffer. 

Employers are reasonable when they understand. They do 
not want a worn-out or half-sick nurse. By supporting the 
nurse in resisting temptations or demands to do more than 
she can do well and by having the foresight to uphold her in a 
resolution to begin with these calls as they must ultimately 
be handled, they will help the nurse to preserve her usefulness 
and increase the efficiency of her work. 



The industrial nursing center having been established, its 
growth is inevitable unless purposely limited. 

There will probably be need for a first aid room, al- 
though it may be possible to have all such work done at the 
plant. The records of all the nursing work may sometimes 
conveniently be kept at the nurse's house. The nurse will 
find it advantageous or even necessary to set aside an hour 
in the evening for workers to come to her either for redress- 
ings or on their personal errands. 

The needs of the visiting nursing service may call for the 
provision of a loan closet containing articles not found in the 
ordinary home, but needed when sickness comes. A cir- 
culating library will bring pleasure to many patients. In a 
small village such a library might be made to grow into a real 
public library. 

The nurse on her rounds will find babies whose mothers do 
not know how to give them proper care. The efficient super- 
vision of a large number of babies means, in addition to calls 
at the homes, individual talks with the mothers, home demon- 
strations in the preparation of food and in the care of the 
child, some central place to which the mothers may bring 
their babies at stated times for weighing, inspection and 
advice. Much follow-up work of a babies' conference of this 
kind is possible, with relatively little extra effort, by the 
industrial visiting nurse on her regular rounds. If she lists 
the homes where there are babies according to streets, it is an 
easy matter to see all the babies in a given district when other 
visits must be made on the same streets. Emergencies and 
special feeding instruction will, however, take more time. 

A baby conference in connection with industrial nursing 
must differ in some respects from one managed by a charita- 
ble organization or by the board of health in a large city. 
Except in a very small, purely industrial village, baby wel- 
fare work, supported by the employer and not by local or- 
ganizations, cannot in any sense take the place of an agency 
widely supported by all classes throughout the community. 

In a baby clinic in a large city, a doctor is in attendance at 


stated times even though he may refer babies needing medical 
care to family doctors. In an informal baby conference (bet- 
ter called " Babies' Day or Babies' Afternoon") connected 
with an industrial nursing center it is usually impractical, if 
not impossible, for local reasons, to have any one doctor in 
attendance. Some physicians in industry might have the 
time to give and the interest in babies which would make 
such a service a pleasure to them. However, the industrial 
nurse in most small villages must depend largely on her own 
ability to enlist the cooperation and support of the family 
doctor of each mother. 

A plan, which has been tried with some success and with 
satisfaction to the local doctors who have happened to need 
the special help that a visiting nurse alone can give in the care 
of difficult feeding cases, will be described as suggesting a 
possible solution of the problem of the care of well babies in a 
small industrial village. Sick babies, necessarily having a 
physician in attendance if visiting nurse care is to be given, 
offer no additional problems in medical and nursing coopera- 

The industrial visiting nurse will find many young babies, 
children of workers, in her daily rounds; children whose 
mothers naturally remain at home after marriage and those 
whose mothers work as long as possible during pregnancy and 
who expect to work again outside the home as soon as they 
can do so after the birth of the baby. Consideration for the 
welfare of the next generation will urge an employer, in a 
town supporting no child welfare agencies, to allow the 
visiting industrial nurses time and opportunity for some, at 
least, of the so badly needed instruction of these mothers and 
for as much supervision of the babies before school age as is 
compatible with industrial nursing immediately and tangibly 
connected with the present welfare of the industry and the 
health of the present force of workers. 

When the nurse has been given this privilege by her em- 
ployer and can observe the improvement in the health, 
strength and happiness of the babies under her care, she 



enters upon the most fascinating, absorbing and satisfying 
branch of industrial nursing. 

At first the babies will be found in the nurse's rounds, but 
later the mothers will, in many cases, hail the nurse as she 
passes in the street or even bring their babies to the nurse's 
house. As the nurse's work becomes known, the opportu- 
nities for getting well babies under observation will increase. 
The local doctors will often refer mothers whom they have 
delivered to the nurses. Consultation of town or county 
records will, in the registration areas, give the births, and the 
nurse can make a call. No mother, however well she may 
understand the care of her baby, will resent one such call. 
Subsequent visits from the nurse and attendance at the 
baby conference will depend entirely on the wishes of the 
mother. Where registration of births is not complete, local 
newspapers will help in finding the babies. The interest of 
friends and neighbors will bring many cases to the nurse's 
attention, but the best advertisement will be the nurse's 
popularity, the word of mouth of mothers who are being 
taught, and the support of the local physicians who are known 
to be interested in child welfare. 

The mother once found is invited to bring her baby to the 
nurse's house on the Babies' Afternoon. If she comes, the 
nurse will weigh and measure the baby and give enough 
general instruction to the mother to interest her, and invite 
her to join the Mothers' Class. A record will be made of the 
name of the mother's physician or of the physician who has 
delivered her and a card sent to him. This card should state 

that Mrs , delivered by him of a child (male or 

female) on , 19. . desires to join the Mothers' Class 

at the nurse's house. The card should further state that 
mothers attending the class are taught the care and folding 
of breast-fed infants and of normal children, that deviation 
from steady growth or any apparent abnormality will be 
reported to him at once, that no mother whose child does not 
seem to progress in a satisfactory way will be allowed to 
continue as a member of the Mothers' Class unless a phy- 


sician is consulted and will direct the subsequent medical 
care of the child. The card should invite suggestions as to 
improvements in the work, and state that visits to the class 
by the doctor will be welcome at any time. 

On instituting such a baby welfare service, a note sent to 
each local physician, explaining the motives and asking sup- 
port and cooperation, is a courtesy which should be appre- 
ciated by the medical profession. If such a note is sent out 
by the employer, his backing and interest are made plain. 

In teaching the mothers, stress should be laid on the simple 
everyday care of well children, the advantages of breast 
feeding and when and how to give additional food, the need 
of cleanliness and how to attain it, the necessity of fresh air 
and exercise, proper clothing and suitable play and the right 
of every child to the care of its own mother in a real home. 
Ignorance and desire for additional money, not need or lack 
of mother's love, are in many cases, the causes of the presence 
in industry of women who would, if they but knew it, be of 
much more value to family and nation if they refrained from 
gainful occupation outside the home until the youngest child 
reaches an age when a mother's care and a home is no longer a 
necessity to his well-being. A nurse can often prove this 
fact to individual mothers through her care of their babies, 
and it is not at all unusual for a woman to say that she has 
decided not to go back to work after the birth of her child 
because she is sure her baby will not have the care she has 
learned to give it. 

One of the greatest pleasures the writer ever experienced 
was the sight, one autumn day, of a street in a poor quarter of 
town. The preceding summer it had been difficult to get 
the mothers to think they had time to take their babies out of 
doors, and often the babies had been placed out for them. It 
happened that every mother on the little street attended the 
Mothers' Class and that nearly every house boasted a young 
baby. On the particular day in question, ten small babies 
within sight were out of doors in boxes, gocarts, pens and on 
the floors of porches. Supper was delayed for some time, a 



call was made on each mother, and neighborhood gossip 
disclosed that the mothers felt it did pay to do all these things 
for the babies, for in spite of a hot summer, not a baby on 
that street had been sick. 

When a baby does become sick, a nurse can do much to 
secure and keep proper medical supervision by encouraging 
the habit of employing a family doctor and discouraging the 
unfortunate drifting from one physician to another which 
some persons consider necessary when a sick member of the 
family is not immediately relieved by the first doctor called, 
and which physicians find so discouraging in their efforts 
for the relief, cure and education of their patients. 

This plan for the supervision of well babies is not by any 
means perfect, but it has been described because the writer 
has not been able to discover any better. Where it was last 
known to have been tried, it was meeting with very real 
success in keeping well babies well. While, in the beginning, 
the work of the industrial nurses was observed by the local 
physicians with great indifference, during the latter part of 
the first summer and to a greater extent during the second 
summer, both well and sick babies in such large numbers 
were referred by the local physicians to the industrial nurses 
that it was only with great difficulty they were able to re- 
spond to all the requests for help. At the end of the second 
summer most of the physicians were ready to try as a general 
community agency, the plan of a community baby confer- 
ence to extend the work already being done by the industrial 
nurses. This was specially gratifying, as a milk station had 
been in existence for one summer before industrial nursing 
had been established and was abandoned because the local 
physicians considered it not suitable to their needs or to the 
needs of the community. 

Prenatal Supervision by Industrial Nurses: The proper care 
of mothers during pregnancy and labor, is now recognized 
everywhere to be the logical beginning of baby welfare work, 
and the industrial nurse, through her knowledge of industry, 
as well as of home conditions, cannot afford to ignore her 


special opportunities to advance the cause wherever her 
work lies. A large community often offers opportunities 
for cooperation in this field with existing agencies, but, in 
the small industrial village, such agencies seldom exist and 
the nurse may be obliged to make the first step herself. The 
support of her employer may depend on the presentation 
of a workable plan which will not demand much additional 
time, funds or space. Fortunately such a plan is perfectly 
practical and may be carried out with little additional effort 
by industrial visiting nurses who already know the town and 
the workers and who have a better chance than other visiting 
nurses for finding, in the early months, a large proportion of 
pregnant women in the industrial group. 

Women employes, who become pregnant, are usually 
forced to remain at home for a time in the early weeks even 
though they return to work later. Where a system of prompt 
visiting is carried out the visiting nurse is sure to see these 
women. The nurse in the plant frequently discovers preg- 
nant women. Others are found as she goes into the 
homes on other errands. As the interest of the nurse 
becomes known, women come to her, and husbands who 
are employe's will sometimes ask the nurse to see their 
wives even though the wives do not work. Few women 
of the working classes consider medical care necessary until 
labor begins, but the visits of the nurse are always welcomed. 
Much may be done, in a very informal way, by simply ad- 
vising any expectant mother seen. All interested visiting 
nurses do much of this sort of casual teaching as they go 
about and, as it is so casual, little note and probably no 
record is made of it. Valuable as this passing attention is, 
a much wider and more lasting good may be accomplished 
by a little effort for thoroughness. 

Needless to say the first duty of the nurse who is consulted 
by a pregnant woman is to discover whether she has seen her 
physician and if she has not, to persuade her to do so at once. 
Patients often hesitate, fearing the expense. Cooperation 
with the local physicians helped to solve the question for one 



industrial nurse. The objection of the women was stated 
to them and they all agreed gladly, at the suggestion of one 
of their number, to rebate, at the time of delivery, all charges 
for office visits made by the women solely for medical ob- 
servation of normal pregnancy. Early consultation enabled 
them to plan their time more economically, to say nothing 
of greater ease to both doctor and patient at the time of de- 

A nurse is often welcomed by the doctor, after he has ex- 
amined the patient, for her ability to observe untoward 
symptoms, make routine urine examinations and give gen- 
eral instruction to the woman in the care she should take of 
herself and the preparations she should make for her confine- 
ment and for her coming child. 

An afternoon at the nurse's house set aside for these 
women, when many are being supervised, will lighten the 
labors of a nurse already well occupied. Many of them will 
gladly call on the nurse if they are sure they will only meet 
other women in the same condition. The routine urine ex- 
aminations may then be made and the necessary instruction 
given in groups or singly. In one visiting nurse center, 
where prenatal care is given, the women are taught to make 
baby clothes and to prepare all pads, etc., for the delivery. 
The women furnish their own material but are taught to 
use old linen for pads, to make over clothes for the baby and 
any other economical measures that appear practical. 

One of the greatest services a sympathetic nurse can render 
a young and probably frightened expectant mother is to give 
her an understanding of what is to come and inspire her with 
confidence that she will endure the trial well and quickly 
forget it. 

If confidence in the nurse is well established during the 
expectant period, the subsequent supervision of the child 
with assured breast feeding and care by its own mother is 
much more likely to be accomplished. 

Visits to the nursing center both by pregnant women and 
by those with children are of additional benefit by getting 


mothers and babies out, and discouraging the close housing 
of the little ones in the winter time. A little air of festivity 
on afternoons given up to this work will make for their seem- 
ing importance in the eyes of the mothers. A hot drink in 
winter and a cool one in summer will also prove an attrac- 
tion and, after a busy morning followed by the walk to the 
nurse's house, may even be needed by both pregnant and 
nursing women. Where there is no fund for purchasing re- 
freshments and possibly in any case, a small sum from each 
woman (perhaps in the form of weekly or monthly dues) 
would provide the necessary food and also give the mothers a 
sense of responsibility in the upkeep of their class. Weekly 
committees might be formed among the women, each pro- 
viding the refreshment*for one afternoon. 

The Industrial Day Nursery: — A so-called welfare agency 
carried on by some employers before the Great War and by 
more since deserves mention. Day nurseries, whether pro- 
vided by employers of labor or under local charitable or 
commercial management, offer, at best, a poor solution to the 
problems of mothers of families without a breadwinner. 
With the growing realization of the child's value to the state 
and the advantages of a normal home in his physical, mental 
and spiritual development, together with the extension of 
state-supported mother's pension systems, we may see the 
time when a day nursery, even for fatherless children, will 
be as much a thing of the past as the old time poor farm care 
of orphans in a progressive and enlightened community. 
When the natural breadwinner of a family is living and 
healthy, something is wrong in a social system that drives or 
coaxes the mother of his young children into gainful occupa- 
tion outside her home. The trend of legislation shows that 
public opinion is being roused to the fact that a young child 
has a right to the care of his mother in a real home, even 
though the state, by pensioning the mother, must take upon 
itself the responsibility of the deceased breadwinner. 

Some socially minded employers of labor realize that they 
would only defeat their purpose by giving women work to 



the detriment of their families. Certain others argue that, 
if the children have good care and suitable food in a day 
nursery at the plant, no harm can come from the employ- 
ment of their mothers. 

Until public opinion fully recognizes the mutual need of 
mother and child for each other and the disastrous results 
to individuals and to the race of separating them, industrial 
nurses will sometimes be asked to aid in the management of 
industrial day nurseries. 1 


The War Labor Policies Board has adopted a resolution setting forth 
the Government's attitude toward the employment of women in war 
industries. The principles embodied in this resolution have been ap- 
proved by all the production and distribution agencies of the Govern- 
ment. Paragraph 3, Section 3, of the resolution reads as follows: 

"The recruiting of mothers of young children for war industries should 
be discouraged." 

"The object of establishing day nurseries in factories is obviously to 
increase and facilitate the employment of mothers of young children. 
The National Consumers' League has always protested against the 
establishment of such day nurseries, as one item in its campaign against 
the employment of mothers of young children. 

" The objections to such employment are manifold. Some of the most 
important being: — 

"(a) A young child normally belongs with its mother in its home. 
Whatever tends to transplant either or both to the factory, 
tends to dismember the home to the injury of both mother and 

"(6) In peace time the one valid reason for the creation of day 
nurseries is that many working class mothers are temporarily 
disabled by suspected tuberculosis, or insanity, or are in the 
hospital for confinement or for surgical care, and the father can- 
not keep the household together unless there is a day nursery to 
tide over the crisis until the mother's return. There is no sug- 
gestion that day nurseries in factories have any such basis. 

" (c) Institutional care of children is, under all circumstances, to be 
avoided, if any better way can be found; and mothers' pensions, 
funds-to-parents acts, the Red Cross Home Service, and nu- 
merous scholarship funds for school children in the elementary 
grades exemplify better ways of providing for the children than 
the best day nursery even outside of a factory. 

"(d) If the excuse for having a day nursery in a factory is that 
mothers of young children are indispensable to present war 
production, the burden of proof is on all who make this unproven 

"So long as there are any cherished daughters of suitable age 


If the employer finds no other immediate solution of his 
own difficulties and those of the working mother, and the 
employment of mothers of little children is a fact, then, 
unquestionably, it is the duty of the industrial nurse to make 
sure by every means permitted her that the children and their 
mothers have all that is possible in the way of care, comfort 
and consideration. An investigation into the disposal of the 
children while their mothers are at work should be made. 
With no day nursery accessible, the babies are rarely left 
where they will have as good care as their mothers would 
give them and almost never are they treated with as much 
love and patience. No matter how poor a mother a woman 
may be, she nearly always leaves her baby with another 
woman a little dirtier, a little more impatient, and with less 
affection for the child. 

If we admit that the baby must suffer by the separation, 
what about the mother who must rise early, prepare break- 
fast, wake, dress and feed her babies, perhaps wash or iron, 
do a little casual housework, take the children to the neighbor 
or to the nursery and be at her own work at seven o'clock? 
At noon she may rush home to nurse the baby or she may be 
obliged to suffer until night because she cannot do so. She 
can hardly avoid losing her milk. If she is a normal woman, 
she cannot escape constant anxiety about her child. At 
night she reverses the work of the morning. She goes for 
the children, takes them home, prepares supper or brings 
in an unwholesome something from the store, puts the babies 

for it in comfortable homes, every exertion should be made to 
get them to do factory work, before any mother should be asked 
to take her little child to the factory. Masses of colored men 
and women, eager to get into industry and now discouraged from 
doing so, should be employed in preference to mothers of young 

"Until these sources of labor power are utterly exhausted, the Con- 
sumers' League will continue its earnest protest both agamst mothers of 
young children going to the factory themselves, and against their taking 
their little ones with them. Such day nurseries are a hideous perversion 
of philanthropy, a travesty of charity." Florence Kelley. 
September 25, 1918. 

From The Churchman. 



to bed, sews, washes, irons, cleans until she is forced to drop 
into bed. Perhaps her rest is broken by a nursing baby, older 
children may disturb her and she will probably be too tired 
to sleep well. She gets farther behind with her work each 
day, takes less care in preparing food, finds herself unable 
to do all that she wants to do, grows discouraged with the 
endless grind and finally becomes sick. The writer has for 
years watched many young mothers in industry and a recent 
review of their names shows few who were able to keep up 
the pace. Where the husband did not or could not support 
his wife at home, the almost certain outcome was that the 
children, or mother and children, became charges on public 
or private charity. Had they been helped to lead normal 
lives, this might have been avoided. As it is, tuberculosis, 
nervous breakdown and other misfortunes have claimed 
many mothers, and their children who have survived are 
growing up in institutions or are struggling for self-support 
without mental or physical preparation. Proper care for 
mothers and children without breadwinners should be pro- 
vided by the state. Mothers' pensions should be provided 
for and accepted by those needing them in the same spirit 
that the public schools are provided by the state and ac- 
cepted by all classes. 

Where mothers of young children are employed, the super- 
vision of the care of the children may be accomplished in two 
ways: — by the day nursery and by carefully selected and 
supervised boarding places in the neighborhood of their 
homes. The industrial nurse who visits in the homes should 
make it her business, if her employer will permit, to visit 
the children of mothers who are employes and work out a 
plan for systematic oversight. The mothers will be appreci- 
ative and many caretakers will take pride in their work 
when they are aware it will be noticed and that the mother 
will be informed when her child has good care, as well as 
when it is neglected. In a small plant in a small town, the 
few babies requiring supervision may be seen while making 
the regular daily calls. In a large city much time and effort 


must be expended in searching out all the babies left with 
others by their working mothers. Careful cooperation with 
the employment office and interviews with all new women 
employes, and with any returning after an absence, should 
discover those with young children. Cooperation with 
nursing and child welfare agencies will do much. 

But the whole thing is wrong, and the industrial nurse 
who is alive to her responsibilities and to her privileges will 
spare no pains to enlist the sympathy and understanding 
of her employer and aid in the forming of a consistent policy 
which will result in the exclusion of the mothers of little 
children from industry. Here the records may help to point 
the argument. If a special file is 1 kept for the disabilities 
and work records of employes who are mothers of young 
children, it cannot fail to yield valuable facts as to the in- 
juries sustained, illnesses suffered, time lost from other causes 
and the amount of their output as compared with women 
having less heavy responsibilities. 

Persons drawing up bills for proposed health insurance 
laws should have this subject in mind together with that of 
maternity benefits for working mothers. 2 

If, for the present, there must be industrial day nurseries, 
the industrial nurses should be ready to help make them 
places which will, as far as possible, provide the children 
with all they need during the day: — light and air, suitable 
food and clothing, protection from the danger of infection, 
means for wholesome play and instruction, and the under- 
standing care of attendants who truly love children. 

In some cities the construction, equipment and manage- 
ment of day nurseries is controlled by law. If the employer 
provides a day nursery, it should have the careful supervision 
of the industrial nurse. All children should have a physical 
examination by the doctor before admission. They should 
be inspected daily by a nurse to see that they are clean, well 
fed and happy, as well as for the prevention of contagion. 

1 See Chapter X, Records. 

2 See footnote, Chapter I, page 6. 



They should have periodical reexaminations by the doctor 
and should receive whatever medical or surgical care is 
indicated. No child under six months or over fourteen 
years should be admitted without special recommendation 
and investigation. 

There must be separate toilets for boys and girls old enough 
to run about. Plenty of space (at least 300 cubic feet for 
each person) 1 must be provided. Window space at least one- 
eighth of the floor space is necessary for light and air, and the 
windows should not open on courts or narrow streets. No 
basement rooms should be used. There should be an isolation 
room, a room with cots for naps, and space for play, indoors 
and out. 

No common toilet articles must be allowed. Each child 
should have towel, wash cloth, tooth brush and cup and they 
should be numbered to correspond with the hooks on which 
they hang. Each child should be identified with the num- 
ber used for his own articles. Dining tables should be 
attractive and the utensils should be handled in a sanitary 

Proper diets must be planned for all ages, and special care 
must be given to the preparation of artificial or supplementary 
feedings for infants of nursing age. The cooperation of the 
company physician or of some baby specialist is essential 
in the feeding of the babies, the prevention of malnutrition 
and the treatment of undernourished children. 

Provision should be made for supervised play and for in- 
struction suited to the age of the children. Those of school 
age will probably be in the public school during school hours. 
Older children may get something of the feeling of a normal 
home by being given some instruction in the care of the little 
ones, and a measure of responsibility for their welfare. 

Any one who establishes a day nursery has responsibilities 
other than the physical care of children. Since it has been 
proved that dependent children do far better in the homes 
of women who, even if poor, give them affection and a normal 
1 Minimum legal requirement in Cleveland. 


home atmosphere, than in institutions however elaborate, 
no one with any understanding of the needs of childhood will 
be satisfied with a social or industrial program which makes 
it possible to separate any little child from a healthy, affec- 
tionate, normal mother while she is forced or enticed into 
work outside her home. 

Little Mothers' Clubs: — The many young girls in industrial 
villages who must have more or less of the care of younger 
brothers and sisters will gain much in capability and self- 
respect if they can be given some training in the care of 
children at the industrial nursing center. A little mothers' 
class, organized on the lines of those already in existence, 1 
will be the means of teaching these young people not only 
to give better care to the younger members of their families, 
but will also teach them to be more intelligent mothers when 
they have babies of their own. A group of young girls or- 
ganized into a club might be of great help to the commu- 
nity by watching out for the welfare of all babies and bringing 
to the nurse's attention those who need her care. 

Further development is possible along similar lines, as home 
nursing classes, Red Cross courses, and lessons in cook- 
ing and sewing. The nurse may find fellow workers in the 
plant who are able and willing to teach others. For instance, 
in one department store, the milliners teach millinery in the 
women's club classes. Men may be found who are natural 
leaders and who will gladly organize the boys and men for 
recreation and study. Although not so common, such leaders 
may also be discovered among the women and girls. 

Recreational, educational and general welfare activities, 
in order to hold the interest of the people, should originate 
in the needs and conscious desires of those to be served. If 
the people are drawn into the actual work, led to think and 
plan for their own welfare, they will profit by the use of the 
nursing center as a community center. To this end the 
natural leaders of the people must be discovered. An up-to- 

1 In New York City such clubs are managed in connection with the 
school nursing. 


date periodical, edited and published by the employes, is a 
great help in stimulating interest and in forming opinion. 

Cooperation between employers and employes is thought 
by many to hold the solution of most of our industrial prob- 
lems. In no field can this cooperation be made of more value 
than in industrial welfare work. The plan, followed in some 
organizations, of having such work in charge of committees 
chosen by representatives from all departments offers op- 
portunity for getting the real opinions of the workers. The 
industrial nurse who is so fortunate as to be identified with 
a firm practicing such cooperation enjoys many advantages 
over one who is employed and directed by one group of per- 
sons while she is expected to serve an entirely different class 
of people. 

The House: — If the industrial nurse has an opportunity to 
assist in the planning of the nursing center she may be able to 
add to its suitability to the work and to its comfort as a 

A house approaching in general appearance the better 
houses in the neighborhood is more in accord with the work 
contemplated than a pretentious structure. The comfort of 
the residents will be enhanced by living quarters separate and 
away from the parts of the house used for other purposes. A 
living room and a dining room, or a room to be used for both 
purposes, a bedroom for each resident, a kitchen and bath 
and probably a room for a housekeeper will be needed. A 
larger place will offer no more comforts and will add mate- 
rially to the housekeeping responsibilities. 

No general plan seems to fit all the varied needs of indus- 
trial villages. Where the nursing center is to be used as a 
general community center a useful nucleus consists of a 
reception room, an assembly hall, a first aid room, office, and 
possibly a rest room. With a sufficient staff use would be 
found for a model apartment for teaching housekeeping and 
for class rooms. 

Public baths, swimming pools, canteens, clubrooms, dance 
halls, bowling alleys, ball grounds, tennis courts, gardens and 


other means for recreation and advancement are provided 
by some employers. In a welfare, industrial or community 
center of such extent, a manager of special executive ability is 
required. A nurse assuming such duties would necessarily 
have on her staff a number of assistants. There is no reason 
why a nurse of executive ability should find the management 
of such a center any more difficult than the management of a 
large hospital. 

In the foregoing chapter, the aim has been to describe, 
with as much detail as possible, a few activities in connection 
with industrial nursing centers which have responded to the 
pragmatic test of Mr. Dooley, that "they work," to suggest 
what employers are trying out with the help of industrial 
nurses, and to indicate what may be the logical development, 
in some towns, of the industrial nursing center as a com- 
munity center as well as a health center. 



a company lunch room as a canteen and as a t lass- 
room for instruction in home problems 

A discussion of industrial nursing would be incomplete 
without special mention of the opportunities of the industrial 
nurse in furthering the provision of proper food for the work- 
ers and in educating them in the principles of nutrition. 

The first aid nurse and the visiting nurse will discover in 
the improper feeding of children, mothers and workers one 
of the main causes of inefficiency, unhappiness and ill health. 
Where there is no canteen service for the workers the indus- 
trial nurse should soon have a variety of recorded facts to 
show the economic value of the provision of well-planned 
warm lunches in clean, comfortable surroundings. 

In trades where poisons, such as lead, are used, it can be 
shown that workers, eating meals at their machines, or in 
corridors, do so without washing, and poisoning may be 
traced to this cause. It may be proved that piece workers do 
not rest during the noon hour if allowed to eat in their work 
rooms. A study may be made of the afternoon output of 
those who remain at their machines and this may be com- 
pared with the output of those who lunch outside. It can 
sometimes be shown that "horse-play" in the plant during 
the noon hour is responsible for accident to workers and for 
injury to machines. Delicate materials are often injured 
when the workers do not leave their places to wash and eat 
their noonday meal. Immoral conditions have been made 
possible by allowing workers to wander at will through tem- 
porarily deserted parts of the plant. 

Even if no direct injury to workers, output or equipment 




can be shown, the cost incident to continual war on the in- 
evitable rats, mice and cockroaches should be placed in the 
balance. Undoubtedly, bits of food left carelessly lying 
about the plant after the workers have had their lunches will 
attract these dangerous pests. 

Most labor laws provide for a lunch period of from forty- 
five to sixty minutes and, unless the workers go to their own 
homes for a warm meal, and for change of air and relaxation, a 
company lunch room is essential for their health and well- 
being, for the protection of materials, machinery and plant, 
as well as for the maintenance of the maximum output. It 
should be clearly understood that the efficient lunch room is 
not a charity. It is an essential part of the equipment of the 
plant. It helps to keep the employes from the pastry shop 
with its rich starchy foods and from the soda fountain at the 
corner drug store. It is so closely associated with the preven- 
tion of industrial injuries and disease that, unless it is man- 
aged by a trained and experienced dietitian, the lunch room is 
the legitimate concern of the industrial nurse. Many nurses 
find it possible to supervise a lunch room in addition to other 
duties. In a large plant, however, the management of the 
company canteen by the industrial nurse would require 
special training or experience as a dietitian. 1 

Physical examination of the lunch room employes should 
be required. Even workers who assist in serving during the 
busy hours, but who are charged to other departments, 
should be examined by a physician. This should be done 
primarily for the protection from infection of those eating in 
the lunch room, but in addition the examination might easily 
yield results in the discovery of remediable conditions, in the 
adjustment of work to workers and of workers to work which 
would prove the economic value, both to the workers and to 
the employer, of general physical examinations as a routine 
policy. Proper toilet facilities for the lunch room employes 
must be provided. It must be made easy for them to keep 
their hands clean and someone must see that this is done. 
1 See Chapter IV, page 20. 



It seems to be the general policy of employers who provide 
lunch rooms for their workers to consider the space, equip- 
ment and often part or even all of the service as a legitimate 
overhead charge for the plant. Some employers provide the 
lunch also without cost to the worker. In most plants, how- 
ever, the workers are charged a sufficient sum to cover the 
actual cost of raw food as well as the cost of preparation and 

Employers sometimes give or sell the privilege of supplying 
the food to local caterers. By this plan both the employer and 
the employe are almost sure to be exploited. The lunch room 
should not escape being a charity to become a money making 
scheme for some outsider. Unless the company considers the 
noonday meal of enough importance to provide for at least 
part of the expense, just as it provides chairs and clothes lock- 
ers, it will be necessary in fixing prices to allow a larger mar- 
gin for accidents, sudden change in market conditions, etc. 

Some employers put the management of the lunch room in 
the hands of a committee of workers, a plan which has been 
known to work to the satisfaction of everyone. One such 
committee manages the finances of the lunch room so wisely 
that the receipts cover the cost of food, service and breakage, 
and there is also a surplus which pays for publishing the 
employes' newspaper, for the expense of the monthly dances 
and often for other amusements. The prices are so low and 
the food is so good that a visitor finds it hard to believe that 
any money can be left over after paying for the food and 
service. The employes of the Bureau of Engraving and 
Printing in Washington conduct a lunch room with space and 
equipment provided by the bureau. That this is successful is 
shown by the fact that seventy per cent of the employes 
patronize it. The management of a lunch room by a com- 
mittee of employes can only be successful if they see the 
wisdom of expert supervision of the actual catering. 

The plan of figuring the overhead charges not assumed by 
the company such as management, service, etc., and making 
this a fixed charge to each patron has been tried. This fixed 



charge is found by computing the cost of management, 
service, breakage, etc., making an allowance for error, 
accident and depreciation. The sum found in this way is then 
divided by the number of meals served during the same 
period. To the fixed charge is added the actual cost of the 
raw material of each portion ordered and the sum is the cost 
of the meal to the worker. 

Specimen Meal Check 1 

Fixed charge 


Beef stew 












Ice cream 




Milk for coffee 




On the other hand, there may be patrons who bring most of 
their lunch from home, and buy only soup or a beverage. If 
the entire fixed charge for service is added to their bill they 
will complain and say that a disproportionate amount is 
being charged to them. This plan is suggested. 2 Obtain 
the figures for the total overhead charges and for the raw 
food cost for any given month. Determine the percentage of 
total expenditure spend for food and for overhead. In the 
above check the expenditure for food is 23c. and fixed charges 
total .07. That gives a proportion of approximately 3 to 1. 
Then for every .03 spent for food .01 should be added for 
fixed charges. Experience has shown that bread and butter 
or coffee and milk are usually taken together, so that the 
objection that less than .01 would have to be charged is 
not a serious one. The menu chart would then read: — 

1 These prices are for illustration only. Unsettled market conditions 
in 1919 forbid any inclusion of price lists for guidance. 

2 Miss Katherine A. Fisher, Instructor in Household Arts, Teachers 
College, Columbia University, kindly revised part of this chapter and 
the suggestion is hers. 



Menu Cost Fixed charge 

Beef stew 9c 2c. 

Potatoes 2c YiP- 

Turnips lc l^c. 

Spinach 3c lc. 

Bread lc He 

Butter lc 

Ice cream 4c lc. 

Coffee lc He. 

Milk for coffee lc J^c. 

The plan might be roughly stated as follows: — 

.02 service charge added to any dish costing .05 to .10. 
.01 " " " " " " " 0.2 to .03. 

.01 " " " " " " or combination of 

dishes costing from .01 to .02. 

The lunch room offers many opportunities for teaching the 
principles of nutrition. Where the full lunch is provided by 
the company without cost to the worker it may be made a 
highly nutritious meal. The workers will partake of most 
of the dishes and will be assured of at least one well-bal- 
anced meal a day. They are more liable to form good food 
habits when good food is put before them. On the other 
hand, if the worker pays the cost of the food, he must be 
free to buy what he will. He may wish to bring part of his 
lunch from home and supplement it in the lunch room. 
False ideas of economy or perverted taste may prevent his 
buying what he needs. Some lunch room managers say they 
cannot educate the workers in the choice of food, but others 
have had a degree of success. The power of suggestion plays 
an active part here. Sometimes an appeal to the general 
desire to get a "bargain" is successful. If the items of food 
are charged for at one price when ordered singly, but are given 
at a noticeable reduction when served as a meal in specified 
combination, many workers will buy a proper lunch and will 
unconsciously form the habit of eating a good meal. 

Industrial nurses and dietitians may also use the lunch 
room and its equipment as a class room in which to give to 
the women and girls instruction in the care of their homes and 



children and in food preparation. In communities where 
girls go to work at fourteen, often not having reached the 
sixth grade, they have little opportunity for learning how to 
keep a pleasant home and to set a good economical table. 
Almost every woman likes to cook, especially if she has an 
appreciative father, brother, husband or sweetheart to feed. 
If the use of the kitchen, therefore, with light, heat and 
equipment is allowed for an hour and a half or two hours after 
the plant closes, cooking and housekeeping classes may be 
formed and carried on without any further expense to the 
company. For a small per capita cost the class can provide 
its own materials and dine on the food cooked. Careful 
planning of the lessons will make this possible even from 
the first day. 

Some firms distribute circulars of advice as to the choice of 
food at different seasons of the year, but the real value of 
such casual means of instruction is open to debate. 

If even a few people can be led to acquire the habit of 
eating good food, a good deal has been accomplished. If 
young girls can be taught to like to cook and care for a house 
because they know how, the health of the next generation 
will be largely assured. 

There are a number of books which will help the industrial 
nurse who must manage a lunch room and who can use its 
facilities in teaching the girls to cook. 1 

In many homes the visiting industrial nurse must teach 
dietetics because that is the one thing needed to improve the 
condition of the adults, maintain the health of the children, 
and perhaps to make possible the natural breast feeding of 
the family baby. 

In dealing with people from other lands we must not forget 
their native customs and preferences. The natural food 
habits of any race which produces a large percentage of 
healthy individuals are probably based to a large extent on 

1 See Bibliography for list of valuable publications which will help 
the industrial nurse in dealing with the home problems of the workers. 
This chapter can only be suggestive of the possibilities which the nurse 
will find for service in this field. 



sound dietetic principles. It would be folly to impose a diet 
of baked beans, Boston brown bread, apple sauce, and plain 
boiled beef and vegetables on the Italian who has thrived for 
generations on green leaves of many kinds, oil, fruit, pastini, 
cheese, and vegetables and meat served with highly seasoned 
sauces. He may better be encouraged in getting what he 
likes. The danger is not in his native diet but in the expense 
or scarcity of the foods to which he has been accustomed. 
This may cause him to adopt other and less wholesome 
habits unless he is made acquainted with suitable substitutes. 
Even the custom of giving unsuitable food to little babies is 
not common when the mother has food she likes and which 
nourishes her, as her baby is then breast fed and, being com- 
fortable, he does not cry and the mother does not strive to 
quiet him by fair means or foul. 

The Polish people coming largely from farms where they 
had milk, cheese, bread from the whole grain, and vegeta- 
bles in abundance, are bewildered at the cost of these things 
in cities. The women have worked in the fields at home, 
spending little time in the preparation of food. Here they 
work in the mills as a matter of course. Instead of milk, 
cereals and vegetables — products from their farms — pro- 
viding a naturally well-balanced diet, the nearest store 
offers nice white bread, cooked meats, nut butter and coffee. 
These foods do not provide adequately for the growth of 
their children, and the absence of bulky foods results in 
sluggish, disordered digestion, with the resulting headaches 
and other symptoms of autointoxication. 

The industrial visiting nurse should have a working 
knowledge of dietetics, and should know in general the kinds 
of foods required for the growth of children and the health of 
adults. She should understand the sources of protein, min- 
eral matter, fats and fat solubles, and carbohydrates, and 
how these may be combined in our common foods to form a 
nutritious and adequate diet. 

We must teach the mother the value of her work in the 
home; we must foster the back yard garden and teach the 



preservation of its products; we must show the value of milk 
(even of goat's milk if there is room for a goat) ; we must not 
thrust aside as of no value any racial food custom. We can 
soon distinguish between habits recently acquired through 
ignorance or for convenience, and customs of proved value. 
If we can show real understanding of these racial customs we 
will often get a hearing in our efforts to introduce more 
important American ideas. If we can introduce the Italian 
salad, the French soup, the hard whole-wheat Swedish bread 
and the Hungarian stew into the home of the average Ameri- 
can worker we will do a national service, and we will in no 
way retard the Americanization of the foreigner who has 
added to the variety on our national table. 

Attention may well be called to two recent publications 
which deal with the subject of the industrial canteen and 
which give definite information concerning this problem. 
One is "Welfare Work in British Munition Factories" (see 
Bibliography) which considers in some detail Canteen Con- 
struction and equipment, with suggestions as to suitable 
dietaries. The other is "Restaurant Facilities for Shipyard 
Workers" (see Bibliography) which goes thoroughly into the 
question of floor plans, equipment and menus and gives re- 
ports from various industrial concerns throughout the country 
who have found the canteen an essential part of their work. 

For a study of food values, presented in such a way that 
the lay person may easily use it as a reference, such a book as 
that by Professor M. S. Rose on "Feeding the Family" is of 
valuable assistance. Food tables are given showing the 
nutritive value of foods by "100 calorie portion," method 
and also the value of dishes in everyday use. "The Newer 
Knowledge of Nutrition" by Professor E. V. McCollum is 
true to its title and sets forth very clearly some of the later 
data that has been worked out in regard to the essentials of a 
"protective diet." 1 

1 Teachers College, Dept. of Household and Institution Management 
will be glad to aid the industrial nurse in pointing her to sources of def- 
inite information concerning canteens and home management problems. 



Before taking a new position, an industrial nurse will do 
well to consider certain things and to take certain precautions 
in order to avoid future misunderstanding or disappoint- 
ment. Important points such as salary and any promised 
increase, vacations, etc., should be stated to the nurse in 
writing for her protection in any future change of adminis- 
tration. This does not mean a contract but simply a letter 
confirming the decisions reached in an interview. Most 
employers and nurses consider contracts unwise. No nurse 
would wish to remain where she was not acceptable and no 
employer would wish to retain a nurse who was dissatisfied. 
Of course an understanding as to reasonable notice of leaving 
should be reached and no nurse is justified in resigning, for 
her own advantage, any position until she has so organized 
her work that it may be carried on after she leaves without 
setback or loss of efficiency. She will be judged as much by 
what she leaves as by what she has done. 

The nurse may be engaged by the busy president or other 
official of a company, but a personal interview with the person 
at the plant to whom she is to be responsible is most de- 
sirable. The nurse will then have a chance to know what is 
expected of her and to show her attitude toward the work. 
Misunderstandings may come from the omission of this 
precaution. During the interview, manager and nurse should 
discuss the relation of the nurse to the company physician, 
the limitations of the nurse in giving medical care and, to 
some extent, the question of cooperation with other depart- 
ments and with local agencies. It is unwise to crowd too 



much into this first interview. Its main advantage is that it 
gives each a chance to decide if they have the same general 
aims and can reasonably expect to work in harmony. 

A preliminary interview with the company physician is 
desirable for exactly the same reasons. 

The nurse must take care that she shall not find herself in 
the position of a substitute for a physician ; that she shall not 
discover after beginning her work that the person to whom 
she is directly responsible has different plans from those of 
the person who engaged her; that she shall have at least a 
reasonable amount of cooperation from the beginning and 
that she shall be allowed some initiative. 

Too much must not be expected at first. The nurse must 
prove herself worthy by doing well what her employer con- 
siders her duties before she can reasonably expect others to 
have much confidence in her ability for wider usefulness. 

An inspection of the plant before taking a position is 
interesting but not necessary and might prove discouraging. 
The least attractive place needs the nurse more than one 
which seems ideal. Much that seems forbidding to an out- 
sider takes on a different character after one is acquainted 
with the industry. If the nurse feels sure of her employer, 
of the general manager, welfare superintendent or other 
member of the staff to whom she is to be responsible, and of 
the company physician, she may safely take a plunge into a 
new position without much further investigation. She will 
be saved from worrying over difficulties she may never have 
to meet if she confines her knowledge of the plant to what she 
is told, until she has entered the work and is in a position to 
learn for herself. The hurried inspection of a large plant 
leaves one confused, but the slow accumulation of a little 
knowledge each day gives, in time, an understanding of the 

Some nurses may wish to make a careful inspection of the 
community. Others, more courageous, may like to go on a 
voyage of discovery, feeling that they may be more needed in 
unattractive places. In primitive communities, where com- 



fortable quarters for the nurse may not exist, the company 
employing her should see that a suitable place, at least 
temporarily, is provided. A nurse cannot be expected to do 
good work and help to raise the living standards of others 
unless she is comfortable herself. The fashion in some mining 
villages of giving the nurse a company house and a salary too 
small to afford household help is unfortunate. Much time 
must be spent in the care of her home which should be given 
to her work or which she needs for relaxation. 

The question of dress should be considered before talcing an 
industrial position. A uniform adds dignity to the nurse, 
makes it easy for the workers to identify her, and sets a good 
example to the women workers by demonstrating a dress 
suitable to the work to be done. In some industries, if the 
nurse's duties are confined to the plant or if she has time to 
change before and after going out, a regulation white uniform 
or the nurse's school uniform is practical. In mills, however, 
where there is moving machinery and where the nurse may 
have to go out of doors to reach different parts of the plant, 
spreading caps and flying skirts and aprons may be a danger 
and are better kept for the first aid room. A nurse going 
among moving machinery may soon find it one of her duties 
to impress upon women and girls the necessity of closely 
fitting uniforms, smoothly dressed hair and closely fitting 
caps, and she should set them an example by making her 
own uniform fit the work she is doing. 

A busy nurse working both in the plant and visiting in the 
homes and perhaps driving and sometimes repairing an auto- 
mobile, cannot keep a white uniform in a presentable condi- 
tion and she cannot find the time for the many changes neces- 
sary if it is kept for indoor use. Furthermore, workers 
sometimes object to having a nurse in uniform call, when, if 
she is inconspicuously dressed, they will welcome her. This 
may be a benighted view but is pardonable in towns where 
the visiting nurses have the name of being charity workers. 

A standardized dress, coat and hat characteristic of the in- 
dividual industrial nurse or nurses of the plant but not recog- 


nizable as specially belonging to visiting nursing solves the 
problem for many nurses in industry. The dress should be 
washable, with white collar and cuffs and the coat and simple 
hat of the same color as the dress. The nurse will then be 
able to wear her uniform to and from her home and be suit- 
ably and inconspicuously dressed in the plant, on the street 
and in the homes of the workers. Care will be needed in 
choosing the material for the dress. It must not specially 
suggest nursing. Nurses in mills have found gray linen of 
a mixed weave satisfactory. Grey Japanese crepe and gray 
cotton poplin have been used, and in department stores dark 
blue washable silk has been worn. A standard material is 
best because, once a suitable dress is planned, it is better 
not to change it. 

When the growth of the work makes an assistant nurse 
necessary the employer should be willing to allow the senior 
nurse to have a voice in choosing the person with whom she 
will have to work and with whom she may be obliged to live. 
The senior nurse should at least have an interview alone with 
the candidate before she is engaged, and the work will gain 
much if she is allowed to find and engage her with the ap- 
proval of her employer. It is sometimes thought that such a 
position should be given to some young woman who has 
grown up in the community. While such a person has the 
advantage of knowing the people and the geography of the 
town, and of having relatives and friends at hand, it is the 
exception, in a small town, to find a nurse, no matter how 
fine and desirable she may be, who can enter the homes of 
people among whom she has grown up and gain their con- 
fidence and appreciation with the same readiness as some 
one unfamiliar with the history of those whom she visits. 

The assistant, having been chosen, deserves the best that 
her senior can give her in opportunities for present service 
and in preparation for wider usefulness. She should have an 
opportunity to learn all that the senior has learned and she 
will learn more readily by taking advantage of her senior's 
experience . 



She should be free to make suggestions for the betterment 
of the work and the employer should know when improve- 
ment has been made possible by her efforts. A little state- 
ment of the work of the assistant nurse may be gracefully 
included in the regular nonstatistical reports. 1 

For her part the assistant nurse owes absolute loyalty and 
cooperation to her senior and should keep her informed of 
all she does or learns which may affect their work in any way. 

With the present shortage of public health nurses, an as- 
sistant industrial nurse should consider that she is serving 
an apprenticeship and should take every opportunity to 
increase her knowledge and develop her powers so that she 
may be able to take advantage of the many opportunities 
for independent work. The senior nurse should make it her 
business to see that the junior has such opportunities as soon 
as she is able to assume the responsibility. The inconvenience 
of teaching a new assistant should be repaid in the satisfac- 
tion of having helped to equip another industrial nurse. 

If there are two or more industrial nurses, the work will 
necessarily be planned by the one in charge, who will find a 
division of inside and outside work advisable. By this means 
both nurses understand all that is being done and each will 
be able to do the work of the other or to instruct a new nurse 
in case of sudden and unavoidable changes. No executive 
is really efficient who has no understudy. However capable 
she may be and however well she may personally manage 
her department, the real test of efficiency comes on the day 
she is suddenly forced to remain away from the plant. The 
real executive is the one whose department will, in her ab- 
sence, continue to run smoothly and which will automatically 
absorb a new worker with little friction or inconvenience. 
This means, in a large nursing department, a head nurse who 
is in charge of all other nurses and of the nursing and all allied 

The plan of having several nurses with distinct duties 
and no supervising nurse is wasteful of time, prevents the 
1 See Chapter X, Records and Reports. 


possibility of giving experience to young nurses, destroys 
unity of plans, purpose and results, and makes unexpected 
changes of personnel times of confusion and friction with the 
resulting chance of workers being neglected. Much, that has 
been so carefully built up, may also at these times be 
destroyed through the ignorance or inexperience of those 
suddenly compelled to assume unaccustomed reponsibilities. 

Large corporations, with branch plants in several localities, 
sometimes employ a supervising nurse whose responsibility 
is the management of nursing service for all plants. This is 
necessarily almost purely executive work, although the or- 
ganization of the service in each plant will require the presence 
and active assistance at the beginning of the supervising 
nurse. Employment of this sort offers many opportunities 
in setting a high standard for industrial nursing and in work- 
ing out practical uniform methods. The service may be so 
planned as to be practically unaffected by changes of per- 
sonnel. The comparative records and reports of such a 
supervising nurse may be made of more value than those of 
isolated nurses working alone. The visits of a supervising 
nurse may mean much to the nurses in outlying plants by 
keeping them in touch with what others are doing, giving 
them the benefit of the viewpoint of a more experienced 
woman and by the real help of the supervisor in the solution 
of their problems. 



No one will question the statement that the nurse can give 
much to industry. Let us see what the world of industry 
offers to the nurse. She should expect something in the way 
of special advantages, personal development, health, happi- 
ness and financial reward and preparation for future oppor- 

The continual contact with people of all sorts, most of 
whom are not ill, gives the nurse who can see through the eyes 
of others, a wide view point. The fact that so large a number 
of those she sees have normal minds and bodies causes her 
to react to people in a clearer headed and more normal way 
than is possible for a nurse, surrounded during her working 
hours solely by the sick and those concerned with them. To 
the nurse more interested in health than in abnormalities, 
this is an advantage to be prized not only for its effect on 
herself but for what it enables her to bring to the sick. 

Work in the business world is valuable training for a nurse. 
It teaches her method and exactness. It tempers her im- 
pulses and develops her sense of justice and of relative values. 
It teaches her the fundamental likeness of all people while 
training her to recognize their individual characteristics and 
to treat them as persons rather than cases. 

It is healthy work, physically as well as mentally, unless 
the nurse falls into the temptation of trying to do more than 
she is physically able to stand. 1 If she yields to this tempta- 
tion she will soon find herself unable to do anything. While 
in some industries the hours are still long, they are usually 
regular; there should be no night work; and Saturday after- 

1 See Miss Mary S. Gardner's " Public Health Nursing," page 157. 



noon, Sunday and holidays are usually free. Where home 
visiting is done there is the advantage of some time spent out 
of doors. Much walking from patient to patient is so waste- 
ful of time that many employers provide an automobile which 
the nurse drives. This is a means of rest and pleasure to the 
nurse unless the traffic conditions of a city make it a source 
of additional nervous strain. But even in a city a car does 
so much to save time, exposure and fatigue to every industrial 
nurse who works in or visits the homes, that it must be con- 
sidered almost a necessity. In large cities home visiting 
may mean many stairs to climb; small towns with detached 
houses are free from this drawback. 

Industrial nursing, while not free from discouraging fea- 
tures, is on the whole happy work, in which conditions im- 
prove and results are obtained, and in which service is repaid 
by confidence and often affection. 

Any statement as to the financial returns from industrial 
nursing made at the present time (1919) may have little bear- 
ing on the future. Exact information is not easy to obtain 
as many salaries are considered by the employer as confiden- 
tial. It seems safe, however, to say that the salary of an as- 
sistant nurse may be expected to exceed somewhat that of a 
staff nurse of a visiting nurse association. The salary of a 
nurse organizing industrial nursing or holding an important 
executive position will depend largely on her ability to earn 
her money. In the business world proved ability is generally 
recognized. Living expenses are seldom included, although 
living quarters are sometimes provided. Uniforms are, as a 
rule, not provided. Uniforms are sometimes laundered and 
when the nurse must change after reaching the plant this 
service is a great convenience to her. But if this involves dis- 
cussion it is more dignified for the nurse to be as independent 
in this as in other personal matters. Vacations with pay are 
usually allowed and the salary is almost always continued 
during short illnesses. An industrial nurse must usually 
make provision for her own hospital care if she should need it. 

No nurse joining the ranks of industry at the present time 



(1919) need feel that she is entering a crowded field. Be- 
cause there are not enough industrial nurses, untrained and 
half-trained women are attempting highly technical and re- 
sponsible work. Industrial nursing is not a "blind alley oc- 
cupation." Opportunities abound. A nurse building on a 
thorough preparation with an open-minded attitude toward 
her work should not fail to advance as far in industrial nurs- 
ing as in any other branch of the nursing profession. 

With the realization of more ideal social and industrial 
relations the industrial nurse of executive ability will, with- 
out doubt, find her services in greater demand under health 
insurance laws and in organizations and industries where 
full understanding and cooperation between employer and 
employe give each an equal voice in the pursuit of their 
common aims. 

While the industrial nurse, with others, will gain strength 
and inspiration by membership and active participation in 
the various nursing, public health, social welfare and safety 
organizations, state, local and national, she must also realize 
that her special work gives her an exceptional and valuable 
experience, and she should be willing to share this with other 
nurses who have not the same opportunities. Pupil nurses 
should be given an idea of the opportunities awaiting them 
in the industrial field. Other public health nurses need the 
knowledge the industrial nurse gains so easily of the normal 
condition of the people she deals with, their racial peculiari- 
ties and the relation of environment and employment to 
health. The industrial nurse should give as generously of 
her experience and allow as much of her work to be seen by 
those interested as is permitted by her employer. She owes 
a duty to her training school, to her alumnae association, 
to the National Organization for Public Health Nursing; 
she can only discharge this duty by taking an active part in 
meetings, serving on committees and doing whatever else 
lies in her power to further the broader cause of public health 


First Aid Rules 

. If the industrial nurse needs a guide for first aid, the following 
" Instructions to Laymen for First Aid Treatment of Common In- 
juries and Disorders," copyright 1914 by Conference Board on 
Safety and Sanitation, are excellent. They are included by special 
permission of Mr. Mangus W. Alexander, Managing Director, 
National Industrial Conference Board. 


Wounds that Bleed 

Abrasions, Cuts, Punctures 

Drop 3% Alcoholic Iodine into wound freely, then apply dry 
sterile gauze to wound and bandage it. Do not otherwise cleanse 

Severe Bleeding 

Place patient at rest and elevate injured part. Apply sterile 
gauze pad large enough to allow pressure upon, above and below 
wound. Bandage tightly. 

If severe bleeding continues apply tourniquet between wound 
and heart and secure doctor's services at once. Use tourniquet 
with caution and only after other means have failed to stop bleeding. 

Nose Bleeding 

Maintain patient in upright position with arms elevated. Have 
him breathe gently through mouth and not blow nose. If bleed- 
ing continues freely press finger firmly on patient's upper lip close 
to nose or have him snuff diluted White Wine Vinegar into nose. 




Injuries Which Do Not Bleed 

Bruises and Sprains 

Cover injury with several layers of sterile gauze or cotton, then 
bandage tightly. Application of heat or cold may help, other 
means are unnecessary. If injury is severe place patient at rest 
and elevate injured part until doctor's services are secured. 

Eye Injuries 
Except Eye Burns 

For ordinary eye irritations flood eye with 4% Boric Acid Solu- 
tion. Remove only loose particles which can be brushed off gently 
with absorbent cotton wrapped around end of toothpick or match. 

Do not remove foreign bodies stuck in the eye. In that case 
and for other eye injuries drop Castor Oil freely into eye, apply 
sterile gauze, bandage loosely and send patient to doctor. 

Splinters or Slivers Embedded in Skin 

Except in Eyes 

If easily reached withdraw with tweezers, then treat same as 
"Wounds that Bleed"; otherwise let doctor attend to it. 

Fire Burns, Electrical Burns and Sunburn 

Do not open blisters. Use Burn Ointment (3% Bicarbonate of 
Soda in Petrolatum) freely on sterile gauze applied directly to 
burn. Cover with several thicknesses of flannel or other soft ma- 
terial, then bandage but not tightly. 

Acid Burns 

Thoroughly flush wound with water, then dry wound, apply 
Burn Ointment and bandage as above. 

Alkaline Burns 

Thoroughly flush wound with water, then flood with White 
Wine Vinegar to neutralize (dilute vinegar for alkaline eye burns), 
dry wound, apply Burn Ointment and bandage as above. 

Eye Burns 
Treat in the same manner as other burns. 




In case of dislocation of finger except second joint of thumb, grasp 
finger firmly and pull it gently to replace joint, then place finger in 
splint and bandage it. In all other cases place dislocated part at rest 
and promptly secure doctor's services. 


Make patient comfortable and secure doctor's services at once. 
Avoid unnecessary handling to prevent sharp edges of broken 
bones tearing artery. If patient must be moved place broken limb 
in as comfortable position as possible and secure it by splint. 

In case of severe bleeding apply sterile gauze and follow direc- 
tions under "Severe Bleeding." 

Dizziness, Headache, Nausea 

Give patient teaspoonful of Aromatic Spirit of Ammonia in hot 
or cold water. 

Chills and Cramps 

Give patient 20 to 30 drops of Jamaica Ginger in hot or cold 
water. If improvement is not speedily obtained send for doctor. 

Frost Bites 

Rub with ice, snow or cold water, then treat as "Fire Burns." 

Insect Bites 
Treat as "Wounds that Bleed." 

Internal Poisoning 

Immediately secure doctor's services. Make patient drink large 
quantities of water, preferably warm, and make him vomit by stick- 
ing one's finger down his throat or by other means. 

Heat Prostration 

Give patient teaspoonful of Aromatic Spirit of Ammonia in hot 
or cold water. In case body feels warm apply cold to it; if necessary 



give cold bath. In case body feels cold and clammy, apply heat 
to it and immediately send for doctor. 

Unconsciousness from Fainting 

Lay patient on his belly and turn his face to one side. Loosen 
all tight clothing. Remove false teeth, tobacco, etc., from mouth. 
Apply cold to head, warmth to hands and feet. If breathing stops, 
treat patient as directed under "Electric Shock." Give no liquids 
by mouth until patient is fully conscious. Then give teaspoonful 
of Aromatic Spirit of Ammonia in hot or cold water. 

Shock, Following Injury 

In case shock is due to severe bleeding control it first as directed, 
under "Severe Bleeding" and summon a doctor. 

Lay patient flat on back and keep him warm with blankets, 
hot-water bottles, etc., and provide plenty of fresh air. Let patient 
inhale fumes of Aromatic Spirit of Ammonia. If fully conscious, 
give patient hot drink or teaspoonful of Aromatic Spirit of Am- 
monia in hot or cold water. 

Unconsciousness from Asphyxiation by Gas, Smoke or Water 
Treat patient as directed under "Electric Shock." 

Electric Shock 

Immediately free patient from electrical circuit using every care 
to protect one's self against electric shock. Then if patient is un- 
conscious, even if he appears dead, lay him on his belly with arms 
extended forward, turn his face to one side, remove false teeth, 
tobacco, etc., from his mouth and draw his tongue forward. 

Kneel, straddling patient's thighs, facing his head, and resting 
your hands on his lowest ribs. Swing forward and gradually bring 
weight of your body upon your hands and thus upon patient's 
back, then immediately remove pressure by swinging backward. 
Repeat this movement about twelve times per minute without 
interruption for hours if necessary, until natural breathing has been 
started and maintained (see cuts). 

Meanwhile send for a doctor, have patient's tight clothing loos- 
ened, keep him warm and provide plenty of fresh air. Do not give 
patient liquids by mouth until he is fully conscious. 



Plate D 



American Social Hygiene Association, 105 W. 40th St., N. Y. C. 
Object: For the repression of prostitution, the reduction of 
venereal disease, and the promotion of sound sex education. 
Information and catalogue of pamphlets upon request. 
Associate membership, $2.00, annual, $5.00, sustaining, 
$10.00. Memberships include quarterly magazine and 
monthly bulletin. 

American Society for the Control of Cancer, 25 W. 45th St., N. Y. 
C, Miss Marion H. Mapelsden, acting executive secretary. 
Object: To disseminate knowledge concerning symptoms, 
diagnosis, treatment and prevention. Publications free on 
request. Annual membership dues, $3.00. 

National Child Labor Committee, 105 E. 22nd St., N. Y. C, Owen 
R. Lovejoy, Secretary (35 State Branches). 
Industrial and agricultural investigations; legislation; studies of 
administration education; delinquency; health; recreation, 
children's codes. Published quarterly "Child Labor Bulle- 
tin." Photographs, slides and exhibits. 

National Child Welfare Association, 70 Fifth Ave., N. Y. C, Chas. 
F. Powlison, General Secretary. 
Originates and publishes exhibit material which visualizes 
conditions affecting the health and education of children. 
Cooperates with communities, educators and organizations 
through exhibits, child welfare campaigns, etc. 



National Committee for Mental Hygiene, 50 Union Square, N. Y. 
C, Clifford W. Beers, Secretary. 
Pamphlets on mental hygiene, mental disorders, feeble- 
mindedness, epilepsy, inebriety, criminology, war neuroses 
and reeducation, social service, backward children, surveys, 
state societies. Mental Hygiene, quarterly, $2.00 a year. 

National Committee for Prevention of Blindness, 130 E. 22nd St., 
N. Y. C, Edward M. Van Cleve, Managing Director, Gordon 
L. Berry, Field Secretary, Mrs. Winifred Hathaway, 

Objects: To furnish information, exhibits, lantern slides, lec- 
tures, publish literature of movement, sample free, quantities 
at cost. Includes N. Y. State Committee. 

National Conference of Social Work, Julia C. Lathrop, President, 
Washington, D. C, Wm. T. Cross, General Secretary, 315 
Plymouth Court, Chicago, 111. 

General organization to discuss principles of humanitarian 
effort and increase efficiency of agencies. Publishes pro- 
ceedings annual meetings. Monthly bulletin, pamphlets, 
etc. Information bureau. Membership, $3.00. 

Children, Henry W. Thurston. 

Delinquents and Correction, Cyrus B. Adams. 

Health, Dr. C. E. A. Winslow. 

Public Agencies and institutions, Albert S. Johnstone. 
The Family, Joanna C. Colcord. 

Industrial and economic problems, Mrs. Florence Kelley. 

The local community, Frances Ingram. 

Mental Hygiene, Maj. Frankwood E. Williams, M. O. R. C. 

Organization of social forces, William J. Morton. 

Uniting native and foreign born in America, Graham Taylor. 

National Organization for Public Health Nursing, 156 Fifth Ave., 
N. Y. C, Ella Phillips Crandall, Executive Secretary. 
Object: To stimulate the extension of public health nursing; 
to develop standards of technique; to maintain a central 
bureau of information. Official organ, The Public Health 
Nurse; subscription included in membership. Dues, $2.00 
and upward. 



Playground & Recreation Association, 1 Madison Ave,. N. Y. C, 
H. S. Braucher, Secretary. 
Playground and community center activities and administra- 

Red Cross Institute for Crippled & Disabled Men, 311 Fourth Ave., 
N. Y. C, Douglas McMurtrie, Director. 
Maintains industrial training classes and an employment 
bureau for crippled men. Conducts research in reeducation 
for disabled soldiers and industrial cripples. Publishes 
reports and reconstruction work here and abroad, and en- 
deavors to establish an enlightened public attitude towards 
the physically handicapped. 

Russell Sage Foundation, For the Improvement of Living Condi- 
tions, 130 E. 22nd St., N. Y. C, John M. Glenn, Director. 
Departments: Charity Organization, Child Helping Education, 
Statistics, Recreation, Remedial Loans, Surveys, and Ex- 
hibits, Industrial Studies, Library, Southern Highland 

State & Municipal Departments of Health, and State Labor De- 

U. S. Dept. of Labor, Industrial conditions, hazards, disease, labor 
laws, Washington, D. C. 

U. S. Dept. of Labor, Children's Bureau, Maternal and child welfare 
and laws regulating the same, Washington, D. C. 

U. S. Public Health Service, Washington, D. C. 

Young Women's Christian Association, National, 600 Lexington 
Ave., N. Y. C. 

To advance physical, social, intellectual, moral and spiritual 
interests of young women. Student, city, town, and county 
centers; physical education, camps, rest rooms, lunch rooms, 
and cafeterias; educational classes; employment, Bible study; 
secretarial training school; foreign work; war work councils. 



Alexander, M. W.: Hiring and Firing, N. Y., Nat'l Assn. of Mfrs., 

Antin, Mary: The Promised Land, N. Y., Houghton, 1912. 
Balch, E. G.: Our Slavic Fellow Citizen, N. Y., Charities Pub. 
Comm., 1910. 

Bergey, D. H.: Principles of Hygiene, 5th ed., revised, Phila., 
Saunders, 1914. 

Brainard, Annie M.: Organization and Administration of Public 

Health Nursing, Macmillan, 1919. 
Broadhurst, Jean: Home and Community Hygiene, Phila., Lippin- 

cott, 1918. 

Byington, M. F.: The Homestead, N. Y., Charities Pub. Comm., 

Cabot, R. C: Social Service and the Art of Healing, N. Y., Moffat, 

Cadbury, Edward: Experiments in Industrial Organization, N. Y., 
Longmans, 1913. 

Connor, Ralph: The Foreigner, N. Y., Doran, 1909, also N. Y., 
Grosset, 1911. 

.Devine, E. T.: Misery and its Causes, N. Y., Macmillan, 1909, also 
N. Y., Macmillan, 1913. 

Devine, E. T.: Principles of Relief, N. Y., Macmillan, 1904. 

Dickinson, S. C: What to Do with the Other Eight Hours, Arizona 
State Bureau Mines, Bulletin 68, Welfare Series 1, 1917. 

Drury, H. B.: Scientific Management: a History and a Criticism, 
N. Y., Longmans, 1915. 

Dunton, W. R.: Reconstruction Therapy, N. Y., Macmillan, 1919. 

Fisher, Boyd: Industrial Loyalty, its Value, its Creation, its Preserva- 
tion, London, Eng., Rutledge, 1918. 

Fisher, Irving: Bulletin SO of the Committee of One Hundred on 
National Vitality, its Waste and Conservation, Govt. Printing 
Office, Washington, D. C, 1910. 

Gardner, M. B.: Public Health Nursing, N. Y., Macmillan, 1916. 




Hayden, George and Alice: Throw Physic to the Dogs, N. Y., Doran, 
1918. (Useful handbook on the avoidance and cure of constipa- 

Hayhurst, E. A. : Survey of Industrial Health, Hazards and Occupa- 
tional Diseases in Ohio, 10 pages, Columbus, Ohio, State Bd. 
of Health, 1914. 

Kelley, Florence: Modern Industry, N. Y., Longmans, 1914. 

Kelly, R. W.: Hiring the Worker, N. Y., Industrial Management 

Kober, G. M., and Hanson, W. C: Diseases of Occupation and 
Vocational Hygiene, Phila., Blackiston, 1916. (Valuable refer- 
ence book for the industrial nurse.) 

Ogden, H. N.: Rural Hygiene, N. Y., Macmillan, 1911. 

Price, G. M.: Modern Factory, N. Y., J. Wiley & Sons, 1914. 

Pyle, W. L.: Manual of Personal Hygiene, 7th ed., revised, Phila., 
Saunders, 1917. 

Richards, E. H.: Cost of Cleanness, N. Y., Wiley, 1908. 

Rosenau, M. J.: Preventive Medicine and Hygiene, 3rd ed., N. Y., 
Appleton, 1917. 

Spooner, H. T.: Industrial Fatigue in its Relation to Maximum 

Output, London, Author, 1917. 
Steiner, E. A.: On the Trail of the Immigrant, N. Y., Revell, 1906. 
Stelzle, Charles: Letters from a Working Man, by an American 

Mechanic, N. Y., Revell, 1908. 
Tolman, W. H., Guthrie, A. W.: Hygiene for the Worker, N. Y., 

American Book Co., 1912. 
U. S. Dept. of Labor: Employers' Welfare Work: Bulletins, 1, 2, 3, 

Washington, D. C. 
U. S. Dept. of Labor: Proceedings of the Employment Managers' 

Conference, Bulletin 227, Washington, D. C, Phila., April 2, 3, 


U. S. Dept. of Labor: Welfare Work in British Munition Factories, 

Bulletin 222, Washington, D. C. 
Veiller, L. T.: Housing Problem, Phila., American Aqademy of 

Science, 1905. 

Wald, L. D.: House on Henry Street, N. Y., Holt, 1915. 
Watkins, G. P.: Welfare as an Economic Quantity, N. Y., Houghton, 

Winslow, C. E. A.: Health of the Worker, N. Y., Metropolitan Life 
Insur. Co., 1913. 




Dickinson, M. B.: Children Well and Happy. Published under 
auspices of Mass. State Fed. Women's Clubs. Manual for 
the Use of the Girls' Health League of Mass. Boston, Le Roy 
Phillips, 1918. 

Duke, Emma: Infant Mortality: Results of a Field Study in John- 
town, Pa., U. S. Dept. of Labor, Children's Bureau, No. 9, 1915. 

Duke, Emma Duncan, B. S. : Infant Mortality: Results of a Field 
Study in Manchester, N. H., U. S. Dept. of Labor, Children's 
Bureau, No. 20, 1917. 

Duke, Emma Duncan, B. S.: Infant Mortality, Montclair, N. J., 
Study of Infant Mortality in a Suburban Community, U. S. 
Dept. of Labor, Children's Bureau, No. 11, 1915. 

Griffiths, J. P. C: The Care of the Baby, 6th ed. revised, Phila., 
Saunders, 1915. 

Kelley, H. W., Bradshaw, M. C: Handbook for School Nurses, 

N. Y., Macmillan, 1918. 
Levy, Julius: Maternal Nursing considered from its Evolutionary 

and Biological Aspects, American Medicine, New Series, Vol. X, 

No. 9, pages 676-682, 1915, also Newark, N. J., Dept. of Health. 
N, Y. (state) Dept of Health, Outline for organizing and directing 

"Little Mothers' Leagues," Albany. 
New Zealand Society for Health of Women and Children, and 

Example of Methods of Baby-saving Work in Small Towns 

and Rural District, Children's Bureau Pub. No. 6. 
Struthers, L. R.: School Nurse, N. Y., Putnam, 1917. 
U. S. Dept. of Labor, Children's Bureau, Breast Feeding, Care of the 

Mother, Wash., D. C, 1918. 
West, Mrs. Max: Prenatal Care, U. S. Dept. of Labor, Children's 

Bureau, Washington, D. C, Pub. No. 4. 
West, Mrs. Max: Infant Care, U. S. Dept. of Labor, Children's 

Bureau, Washington, D. C, Pub. No. 8. 

(Prepared by Miss Katherine Fisher, Department of Household and 
Institution Administration, Teachers' College, Columbia Uni- 

U. S. Dept. of Labor: Welfare Work in British Munition Factories. 
Reprints can be purchased from Supt. of Documents, Govern- 
ment Printing Office. (Bulletin 22.) 



U. S. Dept. of Labor: Bulletin of the National Association of Cor- 
poration Schools. December, 1917. 130 E. 15th Street, New 

Whitney, Anice L.: Lunch Rooms for Employees. "Monthly Re- 
view," Bureau of Labor Statistics, U. S. Dept. of Labor, De- 
cember, 1917. 

Morton, Augustus P. : Welfare Work for Civilian Employees of the 
United States. " Monthly Review," Bureau of Labor Statistics, 
U. S. Dept. of Labor, August, 1918. 

Grum, Fredk. S. : Restaurant Facilities for Shipyard Workers. In- 
dustrial Relations Division, U. S. Shipping Board, Emergency 
Fleet Corporation, Philadelphia, Pa. 

General Electric Co. : The Preparation of Foods for Factory Employ- 
ees, General Electric Company, Cleveland, Ohio. 

Y. W. C. A.: Handbook of the Association Cafeteria, National Board 
of the Y. W. C. A. 

Smedley, Emma: School Lunch Room Management. 

Payser, E. R.: A Quiet Factory Lunch Room. Journal of Home 
Economics, Oct., 1911. 

Lage, Katharine: A Lunch Room for Working Girls in which Simple 
Instruction is given, Journal of Home Economics, Nov., 1910. 

Lage, Katharine: Institutional Supplies, Bureau of State and Mu- 
nicipal Research, Baltimore, Md. 

Smedley, Emma: Institution Recipes. 

Smith, Frances L. : Recipes and Menus for Fifty. 

Smith, Frances L. : More Recipes and Menus for Fifty. 

Nettleton, Bertha E.: One Hundred Portion War Time Recipes, 
Lippincott & Co., Philadelphia, Pa. 

Kittredge, Mabel H. : The Home and its Management, Century Co. 

Gibbs, Winifred S.: The Minimum Cost of Living, Macmillan. 

Rose, Mary Swartz: Feeding the Family, Macmillan. 

Gibbs, Winifred S.: Lessons in the Proper Feeding of the Family, 
Society for Improving the Condition of the Poor. 

McCollum, E. 0. : The Newer Knowledge of Nutrition, Macmillan. 

Stern & Spitz: Food for the Worker. 

Kinne & Cooley: Foods and Household Management, Macmillan. 
Balderston, L. R.: Housewifery, Lippincott. 
Lusk, Graham: The Basis of Nutrition, Yale University Press. 
Stiles, P. G. : An Adequate Dish, Saunders. 




(Prepared by the Playground and Recreation Association 
of America) 

1 Madison Avenue, New York City 

Application may be made direct to the Playground and Recrea- 
tion Association for definite information about folk dances, plays, 
music, and entertainments suitable for industrial centers. 

Boy Scouts of America. Literature on their activities and organi- 
zation, may be obtained from Boy Scouts of America, Headquarters, 
200 Fifth Avenue, N. Y. C. 

Camp Fire Girl literature may be had by applying to Camp 
Fire Girls' Headquarters, 31 E. 17th Street, N. Y. C. 

Girl Scouts of America. Literature on their activities may be 
had from Girl Scout Headquarters, 1 Madison Avenue, N. Y. C. 

Pageants. Outline of a pageant for an industrial center where 
there is very little money for special costuming and where great 
numbers of men and women must be used, can be had from the 
Playground and Recreation Association of America, 1 Madison 
Avenue, New York City, free of charge. (Bulletin No. 1 of the 
Industrial Series.) 

Chesley, A. M.: Social Activities for Men and Boys, N. Y., Assn. 
Press, 1910. (A book taking up the organization and manage- 
ment of boys' clubs; "hikes," athletics, programs for indoor 
track meets; suggestions for entertainments for all sorts of 
special occasions as well as for every day. A book that fills 
the need for every type of entertainment from the simplest to 
the most elaborate.) 

Ferris, H. J.: Girls' Clubs, N. Y., Dutton, 1918 (illustrated). (A 
book containing information about everything connected with 
girls' clubs, their purpose, organization and maintenance. 
Recommended by the Girls' Work Department of the National 
Board of the Young Women's Christian Association as an 
invaluable help in organizing and managing clubs. Will be 
useful to anyone conducting girls clubs, or to anyone just 
starting a club. A practical working handbook.) 

MacKay, C. D.: Patriotic Drama in Your Town, N. Y., Holt, 1918. 
(This book gives simple, inexpensive, easily produced material 
for 4th of July and Christmas that could be readily used in 
industrial centers.) 



Marot, Helen: Creative Impulse in Industry, N. Y., Dutton, 1918. 
(A book which goes into the philosophical as well as the prac- 
tical side of the need for the creative life in industry. "An 
effort to maintain factory efficiency without turning workers 
into dull machines.") 

Weir, L. H. : Vocational Recreation in Indiana, N. Y. C. Playground 
and Recreation Assn. (Bulletin of the Extension Division 
of Indiana University. Gives a broad, practical view of the 
whole subject. Particularly useful for its chapters on social 
and educational activities, games, playgrounds, etc.). 

Weller, C. F.: Recreation in Industries, N. Y. C. Playground and 
Recreation Assn. (Takes up recreation from many angles. 
Describes theaters, movies, the laying out of playgrounds, use 
of leisure. Gives prices of playground equipment. Very com- 


Accidents, increase of reported, 
32; industrial, 32, 33; four 
classes of, 38; minor, 33; pre- 
vention of, 10, 143 

Advertising, see first aid, ad- 
vertising of, 

Advice, circulars of, 146; gratu- 
itous medical, 4 

Alcohol, see stimulants 

Americanization, see foreigners 

Applicant, interview with, 103; 
observation physical condition 
of, 107; blank form for, 120 

Application for employment, 
blank for, 109; copy of, 110 

Asphyxiation, 39, 160-163 

Babies, supervision of, 126; well, 

care of, 127; how to find, 128 
Baby welfare work, see child 
Bibliography, 169 

Cancer, prevention of, 42 

Care, prenatal, 29, 30 

Card, wage, time, 115; average 

earnings, 116; history, 111; 

identification, 113; pass, 117 
Cathartics, 41 

Center, industrial nursing, 124; 
recreation at, 124; development 
of, 139; the house for, 140; as 
a community center, 29 
Charity, 30; lunch room not a, 143 
Charity worker, nurse not a, 15 

Check, specimen meal, 145, 146 

Child welfare, 29, 30, 126-139 

Civic association, 30 

Class, mother's, 128 

Classes, cooking, 147 

Clerk, first aid record, duties of, 
53, 68 

Clinic, baby, 127 

Clubs, little mothers', 139; or- 
ganizing, ability in, 11; 
woman's, 30 

Colds, 44 

Cooperation, 8, 10, 73; with 
health department, 28, 44; with 
employment department, 37; 
with local hospital, 42; with 
employer, 29; with industrial 
physician, 23; with physicians, 
22, with workers, 26 

Community, the industrial nurse 
and the, 28-31 

Community, resources of the, 28 

Committees, management of in- 
dustrial nursing by, 19, 20; 
management of lunch room by, 
144; material relief by, 19 

Compensation, industrial, 5; 
claims for, 32; settlement of, 
32, 38; the industrial nurse as 
witness in, 49, for industrial 
disease, 21 

Conference, baby, 126; helpful, 19 

Contagion, control of, 44, 45; 
medical examination for pre- 




vention of, 22; in industrial 
day nursery, 137; in the em- 
ployes' lunch room, 143 

Day book, 86; sample page, 87; 
duplicate pages for, 98; for each 
station, 59 

Dentist, the, 43; relation of, to 
workers, 43 

Department, employment, func- 
tion of, 101 

Detective, the industrial nurse 
not a, 16, 17 

Diet, see food 

Dietetics, in the homes, 147; 

nurse's knowledge of, 148 
Dietitian, 19; necessary in lunch 

room, 143; the industrial nurse 

as, 143 

Directory, of plant, 28; of commu- 
nity, 28 

Disease, industrial, 12, 79 

Dispensary, evening, 29; works, 29 

Doctor, see physician 

Dress, uniform, advantages of, 
152, 157; suggestions for, 153 

Dressings, plan for handling, 85; 
supplies for, 61; surgical, 61, 62 

Drowning, 39, 40, 160-163 

Drugs, see medicines 

Emergencies, 39, 40 

Employees, dismissal of, 105; 
new, 37; interview with, 121; 
requisition for, 144 

Employer, the charitable, 2 

Employment department, see de- 
partment, employment man- 
agement, see management, em- 

Epidemics, 44 

Ethics, nursing, 78 

Etiquette, professional, 23, 24 

Examination, of employees, med- 
ical, 22, 79; of lunch room em- 
ployees, 143; on return from 
illness, 79; value of nurse in, 23 

Eyes, examination of, 42, 120; 
strain of, 43 

First aid, equipment, 56-64; in- 
struction of workers in, 49; 
inspection of, 64; plan for, 51, 
52, 53, 54; rules, 38, 39, 40; 
outfits for laymen, 34; room, 
7, 26, 27, 32; location of, 51; 
rules for, 159; station, 64; 
advertising of, 34-37 

Food, 41, 142, 143; in workrooms, 
danger of, 142; for injured 
worker, 59; habits, racial, 147 

Foreigners; Americanization of, 
help of industrial nurse in, 4, 
71, 72, 149 

Foremen, cooperation with, 35, 
44, 79 

Funds, benefit, 4; employers' 
objections to, 5; loan, 15; pen- 
sion, 6; sick, 4, 5 

Garden, back yard, 29; nurse's, 29 
Gossip, value of, 36, 48 

Habits, regular, 41; of worker, 43 
Handicapped, 22; advantages of, 
101 ; adjustment of work to, 102 
Headaches, 41 
Hemorrhage, 39, 40 
History, industrial nursing, 1-8 
Home visiting, necessity of, 70 
Hospital, industrial, 1, 21; com- 
pany, 124 



House, nurse's, 124; objections to, 

Hygiene, personal instruction in, 

Hysteria, 42 

Illness, prevention of, 10, 42, 143 
Industrial nurse, see trained nurse 
Infant welfare, see child 
Infections, 32, 34, 35, 37. 

Labor, disturbances, 27; turn- 
over, 5, 99 

Laundry, bag, 63; of uniforms, 
157; work, 63 

Laws, industrial, relation of nurse 
to, 49 

Library, circulating, 126; pro- 
fessional, 66 
Linen, first aid room, 63 
Loan closet, 126 

Loyalty, to employer, 27; to 

senior, 154 
Lunch room, 142; not a charity, 

143, 144; policy of company, 144 

Malingering, 3; duty of nurse in 

case of, 17 
Management employment, for 

nurses, 99; duties of nurse in, 


Maternity, benefits, 6; out of 

wedlock, 46 
Medicines, giving of, 33, 41; 

promiscuous administration of, 

43; list of, for first aid room, 60 
Meetings, for conference, 19, 20; 

informal, 85 
Noon hour, 47, 48, 79 
Nuisances, industrial, abatement 

of, 28 

Nurse, see trained nurse in indus- 

Nurse, industrial, supervising, 155 
Nursery, industrial, day, 133 
Nursing, industrial, beginning of, 
33; cost of, 4, 67, 68; develop- 
ment of, 4, 7; growth of, 7, 8; 
advantages to the nurse of, 156; 
school, 30; payment for, 16 

Orders, first aid, standing, 26, 33, 
39; visiting nursing, 76; written, 

Patients, first aid, four classes of, 
38; return of, for redressings, 82 

Periodical, published by employes, 
119, 140; expenses of, from 
proceeds of lunch room, 144 

Personnel, 68 

Physician, family, 22, 25, 41, 44, 
45, 78, 79; and baby conference, 
127; and sick baby, 130; habit 
of employing, 130; supervision 
of pregnant women by, 131, 
132; private, 22, 25, 41, 45, 77; 
attending, 43, 76; industrial, 
18-44, 54, 61, 64, 77; financial 
arrangements with, 24; part 
time, 23, 25; organization rests 
with, 89; and baby clinic, 127; 
in employment office, 100; rela- 
tion of industrial nurse to, 150 

Record card, industrial, 93; com- 
bination employment and nurs- 
ing, 112 

Record keeping, cooperation in, 92 
Record keeping, plan for, 93 
Records of industrial nurse, 21, 
35, 38, 41, 46, 49; classification 



of, 94; interpretation of, 91; 
necessity of, 91; use of, by in- 
dustrial physician, 92; stand- 
ards for, 91 
Records of industrial visiting 

nurse, 79 
Reference, request for, 110 
Relief, material, 14, 15, 19, 20, 

Reports, 16, 21, 35, 46; daily, 86, 
95; monthly and annual, form 
for, 97; nonstatistical, 96, 154 

Safety, the industrial nurse a pro- 
vision for, 15; lunch room con- 
nected with, 143 
Schedule, weekly, 87 
Service to employees, 117 
Shock, 39, 40; electric, 162 
Social questions in first aid room, 

Station, milk, 130 
Sterilizer, 154 

Stimulants, 61; alcoholic, 60 

Strike, Pullman, 1 

Supervision, of industrial nursing 

in a number of plants, 155; 

medical, 2, 44; prenatal, 130; 

by visiting nurse association, 74 
Supplies, 60, 62, 63; economy in 

use of, 67 
Surgeon, see physician 

Tests, psychological, 103 

Time, economy, of worker's, 47; 

of nurse's, 47 
Toothache, 43 

Trained nurse in industry, first 
entered, 2; contract for, 150; 
early work of, 2; as a general 
nurse, 73; entry to plant, 6; 

dependence of worker on, 43; 
duties of, 18, 21; growth of work 
of, 68, 69; history of, 1-8; not 
a detective, 16, 17; not a sub- 
stitute for a physician, 23, 151; 
preparation of, for executive 
position, 13; qualifications of, 
9, 10, 11; quarters for, 152; 
special training of, 9, 11, 12, 19 
Tuberculosis, 30, 42 

Uniforms, see dress 

Varicose veins, 107 

Visiting nurse association, 16, 
29, 42, 74, 75; cooperation with, 
73, 74; workers' objections to, 

Visiting nurse, general rule for, 76 

Visiting nurse in industry, and the 
physician, 72; responsibilities 
and duties of, 79 

Visiting nurse service in industry, 
organization of, 72 

Visiting nursing, industrial, 29, 84; 
beginning of, 70, 71; develop- 
ment of, 71-79; method in 
getting calls for, 77; standards 
for, 29; technique of, 75, 79 

Welfare, industrial, 1, 3, 4; 
community, 28; cooperation in, 

Welfare department, 18 
Welfare manager, the nurse as, 

Welfare superintendent, 18 

Welfare worker, 45 

Women in industry, 6; causes of 

presence of, 129; pregnant, 131; 

unmarried, pregnant, 46 



Worker, injured, relatives of, 39, 
40; sick, 41, 42, 43, 44; personal 
affairs of, 37, 45, 46, 47, 78 

Workers, organizations of, 19, 21, 
22, 25, 48, 68, 74; employment 
of nurse by, 2, 3, 19; meetings 

of, representatives of, 19; pro- 
vision of medical care by, 21 

Work rooms, visits to, 37; after 
accidents, 40 

Wounds, extensive, treatment of, 
39, 40; infected, see infections 

Printed in the United States of America.